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Cost-utility of collaborative nurse-led self-management support for primary care patients with anxiety, depressive or somatic symptoms: A cluster-randomized controlled trial (the SMADS trial)
- Source :
- International journal of nursing studies. 80
- Publication Year :
- 2017
-
Abstract
- Background Anxiety, depressive and somatoform disorders are highly prevalent and cause a huge economic burden. A nurse-led collaborative care intervention has been set up in order to improve self-management of patients with these mental disorders in primary care in Hamburg, Germany. The aim of this study was to determine the cost-utility of this nurse-led intervention from the health care payer perspective. Methods This analysis was part of a 12-month cluster-randomized controlled trial aiming to increase perceived self-efficacy of primary care patients with anxiety, depressive or somatic symptoms by collaborative nurse-led self-management support compared with routine care. A cost-effectiveness analysis using quality-adjusted life years was performed. Net-monetary benefit regressions adjusted for baseline differences for different willingness-to-pay thresholds were conducted and cost-effectiveness acceptability curves were constructed. Results In total, n = 325 patients (intervention group: n = 134; control group: n = 191) with a mean age of 40 from 20 primary care practices were included in the analysis. The adjusted differences in quality-adjusted life years and mean total costs between intervention group and control group were +0.02 and +€1145, respectively. Neither of the two differences was statistically significant. The probability for cost-effectiveness of the complex nurse-led intervention was 49% for a willingness-to-pay of €50,000 per additional quality-adjusted life year. The probability for cost-effectiveness did not exceed 65%, independent of the willingness-to-pay. Conclusion The complex nurse-led intervention promoting self-management for primary care patients with anxiety, depressive or somatic symptoms did not prove to be cost-effective relative to routine care from a health care payer perspective.
- Subjects :
- Adult
Male
medicine.medical_specialty
Cost-Benefit Analysis
Collaborative Care
Primary care
Anxiety
Disease cluster
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
Patient Education as Topic
law
Intervention (counseling)
Surveys and Questionnaires
Health care
medicine
Cluster Analysis
Humans
030212 general & internal medicine
Cooperative Behavior
Somatoform Disorders
General Nursing
Self-management
business.industry
Depression
Middle Aged
030227 psychiatry
Self Care
Case-Control Studies
Physical therapy
Female
Quality-Adjusted Life Years
medicine.symptom
business
Nurse-Patient Relations
Subjects
Details
- ISSN :
- 1873491X
- Volume :
- 80
- Database :
- OpenAIRE
- Journal :
- International journal of nursing studies
- Accession number :
- edsair.doi.dedup.....033046d1dce62959e91a88d6d1127859