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

J E Bosmans, B Schreuders, Harm Van Marwijk, J H Smit, Oppen P Van, M W van Tulder

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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 euro4795 in the PST group and euro6857 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
    Original languageEnglish
    JournalBMC Fam.Pract.
    Issue number1471-2296 (Electronic)
    Publication statusPublished - 2012


    • Anxiety
    • Depression
    • Health
    • Health Care Costs
    • Mental Health
    • Netherlands
    • Nurses
    • Patients
    • Problem Solving
    • Research
    • analysis
    • methods
    • primary care


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