Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity: cluster-randomised trial

Abstract

Background: Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.AimsTo explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.

Method: A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.

Results: 191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, -0.48 to -0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.

Conclusions: In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.Declaration of interestNone.

Fig. 1

Summary of clinical effectiveness and cost-effectiveness results. (a) Mean Symptom Checklist-13 Depression Scale (SCL-D13) scores during follow-up by treatment group, unadjusted values (solid line represents collaborative care; dashed line represents usual care). (b) Mean health state index (EuroQol 5D-5L) scores during follow-up by treatment group, unadjusted values (solid line represents collaborative care; dashed line represents usual care). (c) Cost-effectiveness plane (primary analysis): distribution of 10 000 bootstrapped simulations of net cost and net quality-adjusted life-year (QALY) pairs (large white square indicates point estimate for incremental cost-effectiveness ratio). (d) Cost-effectiveness acceptability curve (primary analysis).