gms | German Medical Science

Background: Depressive disorders have a high prevalence and cause a large burden of disease. Depression screening is widely applied; still, we identified a research gap concerning feedback interventions after depression screening. GET.FEEDBACK.GP was a multicenter randomized controlled trial (RCT) aimed at feedback interventions to depression screening in a primary care setting.

Objective: This work’s goal was to analyze the cost-effectiveness of the GET.FEEDBACK. GP trial from a societal perspective.

Methods: Participants underwent depression screening in the waiting room of their general practitioner (GP) and were randomized into one of three study arms if screened positive. No-Feedback (NF) participants received no feedback. For participants in the GP-feedback (GF) group, the GP received their patients’ screening results and decided if and how to address the results. In the Patient-GP-feedback (PGF) group, both the GP and the patient received screening results. The time horizon of the trial was one year. Main outcome was the incremental cost-effectiveness ratio (ICER), defined as the ratio of incremental costs (healthcare costs and productivity losses) per quality-adjusted life year (QALY), estimated by means of EQ-5D-5L index scores. Additionally, cost-effectiveness acceptability curves (CEAC) were constructed based on the net monetary benefit, applying linear mixed effects regressions, considering willingness-to-pay (WTP) margins between € 0/QALY and € 160,000/QALY. Four scenario analyses were conducted, one of which considered depression-free-days (DFD). Explorative subgroup analyses regarding gender, age, baseline depression severity, city size, and depression diagnosis were conducted.

Results: 986 (NF: 329, GF: 329, PGF: 328) individuals were included in the analysis. During follow-up, differences in overall costs and effects between groups were statistically not significant. Compared to the remaining study arms, PGF experienced most QALYs and GF had highest costs. GF had an ICER of approx. € 708,000/QALY compared to NF. PGF yielded an ICER of approx. € 39,000/QALY compared to NF and dominated GF by obtaining higher effects at lower costs. CEAC revealed low cost-effectiveness probabilities for GF compared to NF. PGF’s probability of cost-effectiveness ranged between 31% and 69% compared to NF, depending on the assumed WTP margin. Compared to GF, it yielded cost-effectiveness probabilities between 64% and 78%. Cost-effectiveness probabilities were high for people whose suspected depression diagnosis was confirmed one month after screening.

Implication for research: From an economic point of view, (patient-targeted) feedback interventions in primary care cannot be recommended nor ruled out. Cost-effectiveness probabilities of depression screening feedback interventions strongly depend on assumed WTP margins. Further potential for patients with ongoing and severe depressive symptoms was revealed.

Funding: Innovationsfonds/Versorgungsforschung; Project name: GET.FEEDBACK.GP; Grant number: 01VSF17033