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Mental health
Research
Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial
  1. Elizabeth M Camacho1,
  2. Dionysios Ntais1,
  3. Peter Coventry2,
  4. Peter Bower3,
  5. Karina Lovell4,
  6. Carolyn Chew-Graham5,3,
  7. Clare Baguley6,
  8. Linda Gask3,
  9. Chris Dickens7,
  10. Linda M Davies1
  1. 1Manchester Centre for Health Economics, University of Manchester, Manchester, UK
  2. 2Mental Health and Addiction Research Group, University of York, York, UK
  3. 3Centre for Primary Care, University of Manchester, Manchester, UK
  4. 4The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
  5. 5Primary Care & Health Sciences, University of Keele, Staffordshire, UK
  6. 6NHS Health Education North West, Manchester, UK
  7. 7Mental Health Research Group, University of Exeter, Exeter, UK
  1. Correspondence to Dr Elizabeth M Camacho; elizabeth.camacho{at}manchester.ac.uk

Abstract

Objectives To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD).

Setting 36 primary care general practices in North West England.

Participants 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded.

Intervention Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner.

Outcome measures As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months).

Results The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI −30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI −0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000).

Conclusions Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness.

Trial registration number ISRCTN80309252; Post-results.

  • PRIMARY CARE
  • MENTAL HEALTH
  • HEALTH ECONOMICS

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-012514

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    Footnotes

    • Twitter Follow Peter Coventry at @peteyc73, Peter Bower at @Bowercpcman, Elizabeth Camacho @e_camacho_UoM and Linda Davies @lmdHE1

    • Contributors PC, KL, CD, PB, CC-G, CB, and LG were responsible for drafting and revising the original trial protocol. PC was the chief investigator and had overall responsibility for management of the trial. KL, CC-G, LG and CB delivered the training to practice nurses, psychological well-being practitioners and clinical supervisors. EMC and DN wrote the economic analysis plan and cleaned and analysed the data under supervision from LMD. EMC wrote the first draft of the report and revised subsequent drafts. All authors contributed to and approved the final report.

    • Funding This trial was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for Greater Manchester (CLAHRC-GM).

    • Disclaimer The views expressed in this article are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health.

    • Competing interests All authors had financial support from NIHR for the submitted work. LG had other support from Six Degrees—social enterprise that provides step 2 IAPT services.

    • Ethics approval The study was approved by the National Research Ethics Service Committee North West-Preston (NRES/11/NW/0742); research governance approvals were granted by participating primary care trusts and informed consent was given by all patients.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.