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Cost-effectiveness of preventing depression in primary care patients

Randomised trial

Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, and Department of Clinical Psychology, Free University, Amsterdam

GODELIEF WILLEMSE, PhD

Trimbos Institute, Utrecht

MARC KOOPMANSCHAP, PhD

Institute of Medical Technology Assessment, Erasmus Medical Centre, Rotterdam

SIMONE ONRUST, MSc

Trimbos Institute, Utrecht

PIM CUIJPERS, PhD

Department of Clinical Psychology, Free University, Amsterdam, and Trimbos Institute, Utrecht

AARTJAN BEEKMAN, MD, PhD

Department of Psychiatric Epidemiology and Department of Psychiatry, Free University, Amsterdam, and Trimbos Institute, Utrecht, The Netherlands

Correspondence: Filip Smit, Department of Prevention and Early Intervention, Trimbos Institute, PO Box 725, 2500 AS Utrecht, The Netherlands. Tel: +31 30 295 9254; fax: +31 30 297 1111; e-mail: fsmit{at}trimbos.nl

Declaration of interest None. Funding detailed in Acknowledgements.

Background Little is known about the cost-effectiveness of preventing mental disorders.

Aims To study the cost-effectiveness of care as usual plus minimal contact psychotherapy relative to usual care alone in preventing depressive disorder.

Method An economic evaluation was conducted alongside a randomised clinical trial. Primary care patients with sub-threshold depression were assigned to minimal contact psychotherapy plus usual care (n=107) or to usual care alone (n=109).

Results Primarycare patients with sub-threshold depression benefited from minimal contact psychotherapy as it reduced the risk of developing a full-blown depressive disorder from 18% to 12%. In addition, this intervention had a 70% probability of being more cost-effective than usual care alone. A sensitivity analysis indicated the robustness of these results.

Conclusions Over 1 year adjunctive minimal contact psychotherapy improved outcomes and generated lower costs. This intervention is therefore superior to usual care alone in terms of cost-effectiveness.

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