Evidence map›Paper›PMID 32859177›Full record

Trial reportBMC psychiatry2020

Cost-effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression - a cluster-randomized trial.

Christian Brettschneider, Daniela Heddaeus, Maya Steinmann, Martin Härter, Birgit Watzke, Hans-Helmut König

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC psychiatry, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01731717 (Effektivität Und Effizienz Von Behandlungspfaden für Patienten Mit Depressiven Erkrankungen), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT01731717 nacompletednot on this map

Effektivität Und Effizienz Von Behandlungspfaden für Patienten Mit Depressiven Erkrankungen: Stepped Care Als Ansatz für Ein Leitliniengerechtes Und Integriertes Versorgungsmanagement

TypeinterventionalSponsorUniversitätsklinikum Hamburg-EppendorfRan2012 to 2015Enrolled737ConditionsDepressionArmsActive monitoring, Bibliotherapy, Online self-help, Outpatient psychotherapy, Psychiatric treatment
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Psychometric evaluation of the German version of the Recovering Quality of Life (ReQoL) measures in patients with affective disorders.The European journal of health economics : HEPAC : health economics in prevention and care · 2023
    Trial
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Christian BrettschneiderDepartment of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany. c.brettschneider@uke.de.ORCID 0000-0002-5280-1075
Daniela HeddaeusDepartment of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany.
Maya SteinmannDepartment of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany.
Martin HärterDepartment of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany.
Birgit WatzkeInstitute of Psychology, Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmühlestrasse 14, Box 16, CH-8050, Zürich, Switzerland.
Hans-Helmut KönigDepartment of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20251, Hamburg, Germany.

Funding

Bundesministerium für Bildung und Forschung 01KQ1002B
6 · The paper itself

Abstract

backgroundDepression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped care model based on the German National Clinical Practice Guideline "Unipolar Depression" has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versus treatment as usual in depression.

methodsThis prospective cluster-randomized controlled trial included 737 depressive adult patients. Primary care practices were randomized to an intervention (IG) or a control group (CG). The intervention consisted of a four-level stepped care model. The CG received treatment as usual. A cost-utility analysis from the societal perspective with a time horizon of 12 months was performed. We used quality-adjusted life years (QALY) based on the EQ-5D-3L as effect measure. Resource utilization was assessed by patient questionnaires. Missing values were imputed by 'multiple imputation using chained equations' based on predictive mean matching. We calculated adjusted group differences in costs and effects as well as incremental cost-effectiveness ratios. To describe the statistical and decision uncertainty cost-effectiveness acceptability curves were constructed based on net-benefit regressions with bootstrapped standard errors (1000 replications). The complete sample and subgroups based on depression severity were considered.

resultsWe found no statically significant differences in costs and effects between IG and CG. The incremental total societal costs (+€5016; 95%-CI: [-€259;€10,290) and effects (+ 0.008 QALY; 95%-CI: [- 0.030; 0.046]) were higher in the IG in comparison to the CG. Significantly higher costs were found in the IG for outpatient physician services and psychiatrist services in comparison to the CG. Significantly higher total costs and productivity losses in the IG in comparison to the CG were found in the group with severe depression. Incremental cost-effectiveness ratios for the IG in comparison to the CG were unfavourable (complete sample: €627.000/QALY gained; mild depression: dominated; moderately severe depression: €645.154/QALY gained; severe depression: €2082,714/QALY gained) and the probability of cost-effectiveness of the intervention was low, except for the group with moderate depression (ICER: dominance; 70% for willingness-to-pay threshold of €50,000/QALY gained).

conclusionsWe found no evidence for cost-effectiveness of the intervention in comparison to treatment as usual.

trial registrationNCT, NCT01731717 . Registered 22 November 2012 - Retrospectively registered.

Indexed as

DepressionDepressive DisorderAdultCost-Benefit AnalysisHumansProspective StudiesQuality-Adjusted Life YearsCosts and cost analysisDelivery of healthcare, integratedDepressive disorderQuality-adjusted life years

Identifiers

PMID32859177
PMCPMC7456378

What OpenQuestion holds

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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.