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A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial

Published on Dec 1, 2018in BMC Medicine8.285
· DOI :10.1186/s12916-018-1005-y
Anna Fernández14
Estimated H-index: 14
(USYD: University of Sydney),
Juan M. Mendive7
Estimated H-index: 7
+ 26 AuthorsJuan Ángel Bellón19
Estimated H-index: 19
(UMA: University of Málaga)
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Abstract
Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months. With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated. ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010
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References34
Newest
Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care.We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary c...
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BACKGROUND: Not enough is known about universal prevention of depression in adults. OBJECTIVE: To evaluate the effectiveness of an intervention to prevent major depression. DESIGN: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials.gov: NCT01151982) SETTING: 10 primary care centers in each of 7 cities in Spain. PARTICIPANTS: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each cen...
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#2Ryan M. Barber (UW: University of Washington)H-Index: 33
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Background Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Methods Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with...
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#1Juan Ángel Bellón (UMA: University of Málaga)H-Index: 19
Last. Sonia Conejo-CerónH-Index: 7
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Abstract Objective To determine the effectiveness of psychological and/or educational interventions to prevent the onset of episodes of depression. Methods Systematic review of systematic reviews and meta-analyses (SR/MA). We searched PubMed, PsycINFO, Cochrane Database of Systematic Reviews, OpenGrey, and PROSPERO from their inception until February 2014. Two reviewers independently evaluated the eligibility criteria of all SR/MA, abstracted data, and determined bias risk (AMSTAR). Results Twel...
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#1Cathrine Mihalopoulos (Deakin University)H-Index: 29
#2Mary Lou Chatterton (Deakin University)H-Index: 14
Aim The prevention of mental disorders is a growing field and there are interventions that have been demonstrated to prevent some disorders, particularly depression, from developing. The aim of the current study is to update two existing reviews of the cost-effectiveness studies of preventive interventions for mental disorders in order to determine whether such interventions are good value-for-money. Methods A search was undertaken in Medline, PsycInfo and Econlit. The search was limited to arti...
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General practice, long considered the jewel in the crown of the English National Health Service, is being criticized for its small scale, isolation, and lack of accountability. There is growing concern that many general practices cannot respond to new expectations.
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#1Rachael Hunter (UCL: University College London)H-Index: 14
#2Irwin Nazareth (UCL: University College London)H-Index: 59
Last. Michael King (UCL: University College London)H-Index: 71
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Link to this article: http://journals.cambridge.org/abstract_S0033291713002067How to cite this article:R. M. Hunter, I. Nazareth, S. Morris and M. King Modelling the cost­effectiveness of preventing major depression in general practice patients. Psychological Medicine, Available on CJO 2013 doi:10.1017/S0033291713002067Request Permissions : Click here
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#1Kim van Zoonen (University of Pittsburgh)H-Index: 3
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Last. Pim Cuijpers (University of Pittsburgh)H-Index: 104
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Background Depressive disorders are highly prevalent, have a detrimental impact on the quality of life of patients and their relatives and are associated with increased mortality rates, high levels of service use and substantial economic costs. Current treatments are estimated to only reduce about one-third of the disease burden of depressive disorders. Prevention may be an alternative strategy to further reduce the disease burden of depression. Methods We conducted a meta-analysis of randomized...
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#1Juan Ángel Bellón (UMA: University of Málaga)H-Index: 19
Last. Juan de Dios Luna (UGR: University of Granada)H-Index: 32
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Background The ‘predictD algorithm’ provides an estimate of the level and profile of risk of the onset of major depression in primary care attendees. This gives us the opportunity to develop interventions to prevent depression in a personalized way. We aim to evaluate the effectiveness, cost-effectiveness and cost-utility of a new intervention, personalized and implemented by family physicians (FPs), to prevent the onset of episodes of major depression.
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#1Gerhard MüllerH-Index: 2
#2Manuela Pfinder (University Hospital Heidelberg)H-Index: 1
Last. Lisa Lyssenko (University of Freiburg)H-Index: 4
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Mental health promotion programs have been shown to reduce the burden associated with mental distress and prevent the onset of mental disorders, but evidence of cost-effectiveness is scarce. To evaluate the cost-effectiveness of a mindfulness-based mental health prevention program provided by health coaches in a multi-site field setting in Germany. The single-study based economic evaluation was conducted as part of a nonrandomized controlled trial, comparing the effects of a group-based preventi...
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Last. Juan Ángel BellónH-Index: 19
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Background The predictD intervention, a multicomponent intervention delivered by family physicians (FPs), reduced the incidence of major depression by 21% versus the control group and was cost-effective. A qualitative methodology was proposed to identify the mechanisms of action of these complex interventions. Purpose To seek the opinions of these FPs on the potential successful components of the predictD intervention for the primary prevention of depression in primary care and to identify areas...
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#1Eduard MaronH-Index: 23
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AbstractCurrent mental health services across the world remain expert-centric and are based on traditional workflows, mostly using impractical and ineffective electronic record systems or even paper-based documentation. The international network for digital mental health (IDMHN) is comprised of top-level clinicians, regulatory and ICT experts, genetic scientists, and support organizations. The IDMHN has been formed to enable the implementation of digital innovations in clinical practice, hereby ...
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