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Cost-Effectiveness of Detecting and Treating Anxiety and Depression in Frequent GP Attenders

This study examines the cost-effectiveness of detecting and treating anxiety and depression in frequent GP attenders. It compares the outcomes of one-year and two-year frequent attenders, in terms of years spent without depression or anxiety and quality-adjusted life years. The results indicate that detection and treatment of depression are cost-effective, but detection and treatment of anxiety may not be.

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Cost-Effectiveness of Detecting and Treating Anxiety and Depression in Frequent GP Attenders

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  1. Cost-effectiveness of detection and treatment of anxiety and depression in frequent attenders of the GP Judith Bosmans, Frans Smits, Veerle Coupé, Jacob Mohrs, Aart Schene, Henk van Weert, Gerben ter Riet g.terriet@amc.nl

  2. Frequent Attenders • 90-100th centile of attendance frequency in 4 age categories for men and women separately • Somatic, psychological & social problems • Referral and costs • Heartsink for (some) GPs • Why embark on RCTs?

  3. Questions • What would happen if • We detected and treated all depression and anxiety in: • one-year frequent attenders (1yFA) • two-year frequent attenders (2yFA) • In terms of • years spent as non-FA without depression or anxiety • quality-adjusted life years • Compared to • Usual care in Amsterdam SE region, The Netherlands 2007 – 2011 • Δ cost strategy x vs usual care / Δ effects strategy xvs usual care

  4. QALY: Quality Adjusted Life Years Strategy x Quality improvement Quantity improvement Usual care gained by the intervention

  5. . α α = cost-effectiveness ratio = Δ cost / Δ effect

  6. Methods: components of CEA

  7. Example(1 out of 5 cycles): 1yFA withdepressionandtransitionprobabilitiesunderusual care N=49 0.10 0.02 0.12 0.06 0.31 0.39

  8. Results: Usual Care • 70 % percent of 1yFA and 2yFA with depression or anxiety were free of those after one year. • In pFAs 50% stayed depressed and 60% stayed anxious after one year. • 1000 1yFAs spent 86% of time in a nonFA state without depression or anxiety (4322/5000 person-years)

  9. Results: 1000 1yFAs Treatment effect (RR) Δ with usual care Δ with usual care - 330.710/44.1 = - 7.504

  10. Interpretation • Detection and treatment of depression cost- effective at RR <= 0.6, unless spill-over • Detection and treatment of anxiety not cost-effective, even with spill-over • Detection and treatment of depression and anxiety cost effective at RR <= 0.6

  11. Cost-effectiveness of detection and treatment of anxiety and depression in frequent attenders of the GP Judith Bosmans, Frans Smits, Veerle Coupé, Jacob Mohrs, Aart Schene, Henk van Weert, Gerben ter Riet g.terriet@amc.nl

  12. Results: 1000 2yFAs Treatment effect (RR) Δ with usual care Δ with usual care

  13. Strengths & limitations

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