Projects per year
Abstract
Background
In the United Kingdom (UK), around one in four adults over 65 years suffers from depression. Depression case finding followed by alerting patients and their GPs (screening + GP) is a promising strategy to facilitate depression management, but its cost-effectiveness remains unclear.
Aims
To investigate the cost-effectiveness of screening + GP compared to standard of care (SoC) in Northern England.
Method
Conducted alongside the CASCADE study, 1,020 adults aged 65+ were recruited. Participants with baseline Geriatric Depression Scale (GDS) ≥ 5 were allocated to the intervention arm and those less than 5 to SoC. Resource use and EQ-5D-5L data were collected at baseline and six-month. Incremental cost-effectiveness ratio was calculated. Non-parametric bootstrapping was performed to capture sampling uncertainty. The results were presented on cost-effectiveness acceptability curves (CEACs). Sensitivity analyses were conducted to assess the robustness of primary findings. Subgroup analyses were undertaken to examine the cost-effectiveness among participants with more comparable baseline characteristics across treatment groups.
Results
Screening + GP incurred £37 more costs and 0.006 fewer QALYs than SoC. The probability of its being cost-effective was below 5% at £30,000 cost-effectiveness threshold. Sensitivity analyses confirmed the base-case findings. Subgroup analyses indicated screening + GP was cost-effective when patients with baseline GDS 2-7, 3-6, and 4-5 were analysed, respectively.
Conclusions
Screening + GP was dominated by SoC in Northern England. However, subgroup analyses suggested it could be cost-effective if patients with more balanced baseline characteristics were analysed. Economic evaluations alongside randomised controlled trials are warranted to validate these findings.
In the United Kingdom (UK), around one in four adults over 65 years suffers from depression. Depression case finding followed by alerting patients and their GPs (screening + GP) is a promising strategy to facilitate depression management, but its cost-effectiveness remains unclear.
Aims
To investigate the cost-effectiveness of screening + GP compared to standard of care (SoC) in Northern England.
Method
Conducted alongside the CASCADE study, 1,020 adults aged 65+ were recruited. Participants with baseline Geriatric Depression Scale (GDS) ≥ 5 were allocated to the intervention arm and those less than 5 to SoC. Resource use and EQ-5D-5L data were collected at baseline and six-month. Incremental cost-effectiveness ratio was calculated. Non-parametric bootstrapping was performed to capture sampling uncertainty. The results were presented on cost-effectiveness acceptability curves (CEACs). Sensitivity analyses were conducted to assess the robustness of primary findings. Subgroup analyses were undertaken to examine the cost-effectiveness among participants with more comparable baseline characteristics across treatment groups.
Results
Screening + GP incurred £37 more costs and 0.006 fewer QALYs than SoC. The probability of its being cost-effective was below 5% at £30,000 cost-effectiveness threshold. Sensitivity analyses confirmed the base-case findings. Subgroup analyses indicated screening + GP was cost-effective when patients with baseline GDS 2-7, 3-6, and 4-5 were analysed, respectively.
Conclusions
Screening + GP was dominated by SoC in Northern England. However, subgroup analyses suggested it could be cost-effective if patients with more balanced baseline characteristics were analysed. Economic evaluations alongside randomised controlled trials are warranted to validate these findings.
| Original language | English |
|---|---|
| Journal | BJPsych Open |
| Publication status | Accepted/In press - 16 Apr 2025 |
Bibliographical note
This is an author-produced version of the published paper. Uploaded in accordance with the University’s Research Publications and Open Access policy.Projects
- 1 Finished
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NIHR RfPB: Regression discontinuity analysis of case finding for depression in primary care - CASCADE
Fairhurst, C. M. (Principal investigator), Adamson, J. A. (Co-investigator), Baird, K. (Co-investigator), Bell, K. J. (Co-investigator), Cockayne, S. (Co-investigator), Cunningham-Burley, R. A. (Co-investigator) & Torgerson, D. J. (Co-investigator)
1/09/21 → 30/04/24
Project: Research project (funded) › Research