TY - JOUR
KW - Adult
KW - Antidepressive Agents/economics/therapeutic use
KW - Cost-Benefit Analysis
KW - Depressive Disorder, Major/drug therapy/economics/etiology
KW - Economics
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Primary Health Care/economics
KW - Questionnaires
KW - Sick Leave
KW - Stress, Psychological/psychology
KW - Young Adult
AU - K. Uegaki
AU - I. Bakker
AU - M. de Bruijne
AU - A. van der Beek
AU - B. Terluin
AU - H. van Marwijk
AU - M. Heymans
AU - W. Stalman
AU - W. van Mechelen
A1 - 
AB - BACKGROUND: Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC). METHODS: We conducted an economic evaluation from a societal perspective. Quality-adjusted life years (QALYs) and resource use were measured by the EuroQol and cost diaries, respectively. Uncertainty was estimated by 95% confidence intervals, cost-effectiveness planes and acceptability curves. Sensitivity analyses and ancillary analyses based on preplanned subgroups were performed. RESULTS: No statistically significant differences in costs or QALYs were observed. The mean incremental cost per QALY was -euro 7356 and located in the southeast quadrant of the cost-effectiveness plane, whereby the intervention was slightly more effective and less costly. For willingness-to-pay (lambda) thresholds from euro 0 to euro 100,000, the probability of MISS being cost-effective was 0.58-0.90. For the preplanned subgroup of patients diagnosed with stress-related mental disorders, the incremental ratio was -euro 28,278, again in the southeast quadrant. Corresponding probabilities were 0.92 or greater. LIMITATIONS: Non-significant findings may be related to poor implementation of the MISS intervention and low power. Also, work-presenteeism and unpaid labor were not measured. CONCLUSIONS: The minimal intervention was not cost-effective compared to usual care for a heterogeneous patient population. Therefore, we do not recommend widespread implementation. However, the intervention may be cost-effective for the subgroup stress-related mental disorders. This finding should be confirmed before implementation for this subgroup is considered.
BT - Journal of affective disorders
C5 - Financing & Sustainability
CP - 1-3
CY - Netherlands
DO - 10.1016/j.jad.2009.04.012
IS - 1-3
JF - Journal of affective disorders
N2 - BACKGROUND: Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC). METHODS: We conducted an economic evaluation from a societal perspective. Quality-adjusted life years (QALYs) and resource use were measured by the EuroQol and cost diaries, respectively. Uncertainty was estimated by 95% confidence intervals, cost-effectiveness planes and acceptability curves. Sensitivity analyses and ancillary analyses based on preplanned subgroups were performed. RESULTS: No statistically significant differences in costs or QALYs were observed. The mean incremental cost per QALY was -euro 7356 and located in the southeast quadrant of the cost-effectiveness plane, whereby the intervention was slightly more effective and less costly. For willingness-to-pay (lambda) thresholds from euro 0 to euro 100,000, the probability of MISS being cost-effective was 0.58-0.90. For the preplanned subgroup of patients diagnosed with stress-related mental disorders, the incremental ratio was -euro 28,278, again in the southeast quadrant. Corresponding probabilities were 0.92 or greater. LIMITATIONS: Non-significant findings may be related to poor implementation of the MISS intervention and low power. Also, work-presenteeism and unpaid labor were not measured. CONCLUSIONS: The minimal intervention was not cost-effective compared to usual care for a heterogeneous patient population. Therefore, we do not recommend widespread implementation. However, the intervention may be cost-effective for the subgroup stress-related mental disorders. This finding should be confirmed before implementation for this subgroup is considered.
PP - Netherlands
PY - 2010
SN - 1573-2517; 0165-0327
SP - 177
EP - 187
EP - 
T1 - Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: Results of an economic evaluation alongside a pragmatic randomised control trial
T2 - Journal of affective disorders
TI - Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: Results of an economic evaluation alongside a pragmatic randomised control trial
U1 - Financing & Sustainability
U2 - 19439362
U3 - 10.1016/j.jad.2009.04.012
VL - 120
VO - 1573-2517; 0165-0327
Y1 - 2010
ER -