1. Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial.
- Author
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Bosmans, Judith E., Schreuders, Bettine, van Marwijk, Harm W. J., Smit, Jan H., van Oppen, Patricia, and van Tulder, Maurits W.
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MENTAL illness treatment , *CONFIDENCE intervals , *COST effectiveness , *MEDICAL care , *MULTIVARIATE analysis , *PATIENTS , *PRIMARY health care , *PROBLEM solving , *QUESTIONNAIRES , *RESEARCH funding , *SCALES (Weighing instruments) , *COST analysis , *STATISTICAL power analysis , *RANDOMIZED controlled trials , *QUALITY-adjusted life years , *DATA analysis software - Abstract
Background: Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. Methods: An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. Results: There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. Conclusions: PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. Trial registration: Nederlands Trial Register ISRCTN51021015 [ABSTRACT FROM AUTHOR]
- Published
- 2012
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