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BMC Primary Care
Published in: BMC Primary Care 1/2012

Open Access 01-12-2012 | Research article

Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial

Authors: Judith E Bosmans, Bettine Schreuders, Harm WJ van Marwijk, Jan H Smit, Patricia van Oppen, Maurits W van Tulder

Published in: BMC Primary Care | Issue 1/2012

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Abstract

Background

Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems.

Methods

An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC.

Results

There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings.

Conclusions

PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group.

Trial registration

Nederlands Trial Register ISRCTN51021015
Appendix
Available only for authorised users
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Metadata
Title
Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial
Authors
Judith E Bosmans
Bettine Schreuders
Harm WJ van Marwijk
Jan H Smit
Patricia van Oppen
Maurits W van Tulder
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2012
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-13-98

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