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

Background: 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 ab...

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Authors: Fernandez, A., Mendive, J.M., Conejo-Ceron, S., Moreno-Peral, P., King, M., Nazareth, I., Martin-Perez, C., Fernandez-Alonso, C., Rodriguez-Bayon, A., Aiarzaguena, J.M., Monton-Franco, C., Serrano-Blanco, A., Ibanez-Casas, I., Rodriguez-Sanchez, E., Salvador-Carulla, L., Garay, P.B., Ballesta-Rodriguez, M.I., LaFuente, P., Munoz-Garcia, M.D., Minguez-Gonzalo, P., Araujo, L., Palao, D., Gomez, M.C., Zubiaga, F., Navas-Campana, D., Aranda-Regules, J.M., Rodriguez-Morejon, A., Luna, J.D., Bellon, J.A.
Format: article
Status:Published version
Publication Date:2018
Country:España
Institution:Universidad de Zaragoza
Repository:Zaguán. Repositorio Digital de la Universidad de Zaragoza
OAI Identifier:oai:zaguan.unizar.es:69782
Online Access:http://zaguan.unizar.es/record/69782
Access Level:Open access
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spelling A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trialFernandez, A.Mendive, J.M.Conejo-Ceron, S.Moreno-Peral, P.King, M.Nazareth, I.Martin-Perez, C.Fernandez-Alonso, C.Rodriguez-Bayon, A.Aiarzaguena, J.M.Monton-Franco, C.Serrano-Blanco, A.Ibanez-Casas, I.Rodriguez-Sanchez, E.Salvador-Carulla, L.Garay, P.B.Ballesta-Rodriguez, M.I.LaFuente, P.Munoz-Garcia, M.D.Minguez-Gonzalo, P.Araujo, L.Palao, D.Gomez, M.C.Zubiaga, F.Navas-Campana, D.Aranda-Regules, J.M.Rodriguez-Morejon, A.Luna, J.D.Bellon, J.A.Background: 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. Methods: 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. Results: With a willingness-to-pay threshold of (sic)10, 000 ((sic)8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to (sic)30, 000 ((sic)25, 704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Conclusions: 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.2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://zaguan.unizar.es/record/69782reponame:Zaguán. Repositorio Digital de la Universidad de Zaragozainstname:Universidad de ZaragozaInglésinfo:eu-repo/grantAgreement/ES/DGA/RD06-0018-0020-Aragon groupinfo:eu-repo/grantAgreement/ES/DGA/RD12-0005-0006-Aragon groupinfo:eu-repo/grantAgreement/ES/ISCIII/PS09-00461info:eu-repo/grantAgreement/ES/ISCIII/PS09-00849info:eu-repo/grantAgreement/ES/ISCIII/PS09-01095info:eu-repo/grantAgreement/ES/ISCIII/PS09-02147info:eu-repo/grantAgreement/ES/ISCIII/PS09-02272info:eu-repo/grantAgreement/ES/ISCIII/RD06-0018info:eu-repo/grantAgreement/ES/ISCIII/RD12-0005-0001info:eu-repo/semantics/openAccessoai:zaguan.unizar.es:697822026-05-29T13:59:51Z
dc.title.none.fl_str_mv A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
title A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
spellingShingle A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
Fernandez, A.
title_short A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
title_full A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
title_fullStr A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
title_full_unstemmed A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
title_sort A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial
dc.creator.none.fl_str_mv Fernandez, A.
Mendive, J.M.
Conejo-Ceron, S.
Moreno-Peral, P.
King, M.
Nazareth, I.
Martin-Perez, C.
Fernandez-Alonso, C.
Rodriguez-Bayon, A.
Aiarzaguena, J.M.
Monton-Franco, C.
Serrano-Blanco, A.
Ibanez-Casas, I.
Rodriguez-Sanchez, E.
Salvador-Carulla, L.
Garay, P.B.
Ballesta-Rodriguez, M.I.
LaFuente, P.
Munoz-Garcia, M.D.
Minguez-Gonzalo, P.
Araujo, L.
Palao, D.
Gomez, M.C.
Zubiaga, F.
Navas-Campana, D.
Aranda-Regules, J.M.
Rodriguez-Morejon, A.
Luna, J.D.
Bellon, J.A.
author Fernandez, A.
author_facet Fernandez, A.
Mendive, J.M.
Conejo-Ceron, S.
Moreno-Peral, P.
King, M.
Nazareth, I.
Martin-Perez, C.
Fernandez-Alonso, C.
Rodriguez-Bayon, A.
Aiarzaguena, J.M.
Monton-Franco, C.
Serrano-Blanco, A.
Ibanez-Casas, I.
Rodriguez-Sanchez, E.
Salvador-Carulla, L.
Garay, P.B.
Ballesta-Rodriguez, M.I.
LaFuente, P.
Munoz-Garcia, M.D.
Minguez-Gonzalo, P.
Araujo, L.
Palao, D.
Gomez, M.C.
Zubiaga, F.
Navas-Campana, D.
Aranda-Regules, J.M.
Rodriguez-Morejon, A.
Luna, J.D.
Bellon, J.A.
author_role author
author2 Mendive, J.M.
Conejo-Ceron, S.
Moreno-Peral, P.
King, M.
Nazareth, I.
Martin-Perez, C.
Fernandez-Alonso, C.
Rodriguez-Bayon, A.
Aiarzaguena, J.M.
Monton-Franco, C.
Serrano-Blanco, A.
Ibanez-Casas, I.
Rodriguez-Sanchez, E.
Salvador-Carulla, L.
Garay, P.B.
Ballesta-Rodriguez, M.I.
LaFuente, P.
Munoz-Garcia, M.D.
Minguez-Gonzalo, P.
Araujo, L.
Palao, D.
Gomez, M.C.
Zubiaga, F.
Navas-Campana, D.
Aranda-Regules, J.M.
Rodriguez-Morejon, A.
Luna, J.D.
Bellon, J.A.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
description Background: 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. Methods: 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. Results: With a willingness-to-pay threshold of (sic)10, 000 ((sic)8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to (sic)30, 000 ((sic)25, 704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Conclusions: 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.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://zaguan.unizar.es/record/69782
url http://zaguan.unizar.es/record/69782
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/grantAgreement/ES/DGA/RD06-0018-0020-Aragon group
info:eu-repo/grantAgreement/ES/DGA/RD12-0005-0006-Aragon group
info:eu-repo/grantAgreement/ES/ISCIII/PS09-00461
info:eu-repo/grantAgreement/ES/ISCIII/PS09-00849
info:eu-repo/grantAgreement/ES/ISCIII/PS09-01095
info:eu-repo/grantAgreement/ES/ISCIII/PS09-02147
info:eu-repo/grantAgreement/ES/ISCIII/PS09-02272
info:eu-repo/grantAgreement/ES/ISCIII/RD06-0018
info:eu-repo/grantAgreement/ES/ISCIII/RD12-0005-0001
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv
publisher.none.fl_str_mv
dc.source.none.fl_str_mv reponame:Zaguán. Repositorio Digital de la Universidad de Zaragoza
instname:Universidad de Zaragoza
instname_str Universidad de Zaragoza
reponame_str Zaguán. Repositorio Digital de la Universidad de Zaragoza
collection Zaguán. Repositorio Digital de la Universidad de Zaragoza
repository.name.fl_str_mv
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