Trial reportBMC psychiatry2017
Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment: randomized controlled trial.
Trial report in BMC psychiatry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 39 citations in OpenAlex.
- A systematic review of economic analyses of psychological interventions and therapies in health-related settings.BMC health services research · 2022Pooled it
- Pooled it
- Prevention of depression in adults with long-term physical conditions.The Cochrane database of systematic reviews · 2021Pooled it
- Low vision rehabilitation for better quality of life in visually impaired adults.The Cochrane database of systematic reviews · 2020Pooled it
- Cost-utility analysis of a collaborative and stepped care model in patients with mental disorders in German primary care (the COMET study).BMC psychiatry · 2025Trial
- Trial
- Cost-Effectiveness of Stepped Care Versus Stratified Care for Pediatric Anxiety Disorders: A Pilot Evaluation in Routine Care.Child psychiatry and human development · 2026Article
- A stepped-care strategy for cognitive behavioral therapy for insomnia in chronic spinal pain-protocol of a randomized clinical trial (the StepUp study).Sleep advances : a journal of the Sleep Research Society · 2026Article
- Social Care Costs of Depressive Symptoms in the English Older Population: Then Role of Housing Quality Improvements.Innovation in aging · 2025Article
- The Identification and Management of Subthreshold Depression and Anxiety in Primary Care for People With Long-Term Conditions.Depression and anxiety · 2025Review
- Article
- The Basic VRS-Effect Study: Clinical Trial Outcomes and Cost-Effectiveness of Low Vision Rehabilitation in Portugal.Ophthalmology and therapy · 2023Article
- Trends in low vision service utilisation: A retrospective study based on general population healthcare claims.Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) · 2022Article
- Perspectives on Implementing the Patient Health Questionnaire-4 in Low-Vision Service Organizations to Screen for Depression and Anxiety.Translational vision science & technology · 2022Article
- Article
- Design of a health-economic Markov model to assess cost-effectiveness and budget impact of the prevention and treatment of depressive disorder.Expert review of pharmacoeconomics & outcomes research · 2021Article
- Considering the societal perspective in economic evaluations: a systematic review in the case of depression.Health economics review · 2020Review
- Visual Impairment and Mental Health: Unmet Needs and Treatment Options.Clinical ophthalmology (Auckland, N.Z.) · 2020Review
- Economic Evaluations of Stepped Models of Care for Depression and Anxiety and Associated Implementation Strategies: A Review of Empiric Studies.International journal of integrated care · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the cost-effectiveness of stepped-care versus usual care within low vision rehabilitation.
methodsAn economic evaluation from a societal perspective was performed alongside a multicenter randomized controlled trial. Data were collected by masked assessors during 24 months. Included were 265 older adults with vision impairment and subthreshold depression and/or anxiety. They were randomly assigned to stepped-care plus usual care (n = 131) or usual care alone (n = 134). Stepped-care comprised 1) watchful waiting, 2) guided self-help based on cognitive behavioral therapy, 3) problem solving treatment, and 4) referral to a general practitioner. Costs were based on direct healthcare costs and indirect non-healthcare costs. Main outcome measures were quality-adjusted life years (QALYs) and the cumulative incidence of major depressive, dysthymic and/or anxiety disorders. Secondary outcomes were symptoms of depression and anxiety.
resultsBased on intention-to-treat, significant differences were found in the incidence of depressive/anxiety disorders (mean difference 0.17; 95% CI 0.06 to 0.29) and symptoms of anxiety (mean difference 1.43, 95% CI 0.10 to 2.77) in favor of stepped-care versus usual care; no significant difference was found for QALYs and symptoms of depression. Societal costs were non-significantly lower in the stepped-care group compared with the usual care group (mean difference: -€877; 95% confidence interval (CI): -8039 to 5489). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 95% or more at a willingness-to-pay of €33,000 per disorder prevented. The probability that stepped-care was cost-effective compared to usual care was 59% or more for a ceiling ratio of 0 €/QALY and increased to 65% at 20000 €/QALY.
conclusionsThis economic evaluation shows that stepped-care is dominant to usual care, with a probability of around 60%, due to its clinical superiority and its modest cost savings. However, it depends on the willingness-to-pay of decision makers whether or not stepped-care is considered cost-effective compared with usual care.
trial registrationidentifier: NTR3296 , date: 13-02-2012.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.