gms | German Medical Science

Background and status of (inter)national research: In order to reduce the health burden and the health care costs caused by the most common mental disorders, health care systems throughout Europe have tried to improve services and treatment choices. Recently, a collaborative and stepped care (CSC) model for patients with depressive disorders, anxiety disorders, somatoform disorders, alcohol-related disorders and comorbidities was developed and implemented under routine care conditions Germany.

Research question and objective: The aim of this study was to determine the cost-effectiveness of a CSC model in patients with depressive disorders, anxiety disorders, somatoform disorders and alcohol-related disorders in German routine care from a societal perspective with a 6-month follow-up.

Method or hypothesis: This study was part of a cluster-randomized controlled trial to compare a CSC model with treatment as usual (TAU) in patients with mental disorders in German routine care. The CSC model consisted of a network of health care providers, an online scheduling platform for referral to psychotherapists and psychiatrists, eight stepped care interventions, monitoring and case management. Health-related quality of life was measured by the EQ-5D-5L and quality-adjusted life years (QALYs) were calculated based on the EQ-5D index. Health care service utilization was assessed using an adapted version of the German Client Socio-Demographic and Service Receipt Inventory. The cost-effectiveness of the CSC model compared with TAU was analyzed on the basis of the incremental cost-utility ratio (ICUR) with QALYs as measure of health effect. The uncertainty of the ICUR was assessed using cost-effectiveness acceptability curves based on net-benefit regressions.

Results: In total, n=307 patients in the CSC and n=308 patients in the TAU group were included, with a mean age 38 and 43 years, respectively. The CSC model had higher costs (+2,602€) and less health effects (−0.01 QALY), such that CSC was dominated by TAU. There were however no differences in adjusted mean QALYs and total costs between the CSC group (0.43 QALY, 13,577€) and the TAU group (0.43 QALY, 13,278€) during the 6-month follow-up. Only the adjusted mean costs for psychiatric outpatient physician services were statistically significantly higher in the CSC group (+354€; p < 0.001). The probability of cost-effectiveness of the CSC model was 40% at a willingness-to-pay (WTP) of 0€ and 32% at a WTP of €50,000 per additional QALY.

Discussion: The CSC model for patients with depressive disorders, anxiety disorders, somatoform disorders and alcohol-related disorders was unlikely to be cost-effective compared with TAU from a societal perspective during the 6-month follow-up.

Practical implications: The higher mean costs for psychiatric outpatient physician services might be an indicator for the general practitioners in the CSC group being able to refer patients to psychotherapists and psychiatrists more frequently through the network of health care providers.

Appeal for practice (science and/or care) in one sentence: Further research is needed in order to analyze the cost-effectiveness of the CSC model with a longer follow-up.

Funding: BMBF-Strukturförderung Versorgungsforschung; 01GY1602