Mobiele menu

Current and future regimes for preventing depression: acceptability and population-level cost-effectiveness

Projectomschrijving

Kosteneffectiviteit van depressiepreventie

In de afgelopen jaren is flink geïnvesteerd in depressiepreventie. Veel preventieve interventies blijken effectief te zijn. Toch zijn er nog onbeantwoorde vragen. Maakt depressiepreventie de zorg voor depressie als geheel kosteneffectiever? En wat gebeurt er wanneer we preventie op nog grotere schaal aanbieden, bijvoorbeeld als e-health interventies? Dit onderzoek laat zien dat zien dat het voorkomen van een eerste depressie en terugkerende depressies, de zorg voor depressie kosteneffectiever maakt. Vooral e-health interventies helpen de zorg betaalbaar te houden en bereiken bovendien veel mensen. De onderzoekers hebben panels geraadpleegd van zorggebruikers, zorgaanbieders en zorgfinanciers. Zo werd nagegaan welke interventies acceptabel zijn voor al die partijen. Vervolgens werd een gezondheidseconomisch rekenmodel gemaakt. Investeren in preventie en terugvalpreventie blijkt dus gezondheidswinst op te leveren en ook e-health kan de zorg betaalbaar houden.

Verslagen


Samenvatting van de aanvraag

Both the Netherlands Ministry of Health (VWS) and the Netherlands Organisation for Health Research and Development (ZonMw) have played an important role in the development, evaluation and implementation of preventive interventions for depressive disorders. Based on the currently available evidence, it is now believed that prevention (as an adjunct to treatment) can make a significant contribution to reducing the disease burden of depressive disorder: several preventive interventions for depression have been shown to be acceptable, effective, cost-effective and scalable -- especially when offered as internet-based self-help interventions. Wider proliferation of these interventions could be of great public health significance. After all, depression is the single leading cause of non-fatal disease burden and has substantial economic consequences. This calls for a health care system which is well-calibrated to deal with the disorder. To that end, the health care system needs to offer a mix of interventions which is at once acceptable, effective and economically affordable. Yet it is a difficult task to identify which particular combination of interventions might meet these criteria. Following a successful strategy in Australia we propose to use a computational (simulation) model to assess the population-level cost-effectiveness of preventing depression. The computational model has been developed by the Trimbos Institute (Netherlands Institute of Mental Health and Addiction) in corporation with PriceWaterhouseCoopers and was financed by the Ministry of Health. The model can assess population-level cost-effectiveness of the current health care system with and without preventive interventions. This would help to quantify health gains (reductions in DALY disease burden) and entailing budget impacts (in euro) stemming from prevention, as it has been organised in the Netherlands since 2008. It is also important to look ahead, and come up with an optimal health care scenario where prevention is offered on a larger scale and more often via the internet. In this context it is worth noting that currently only 0.02% of the Dutch health care budget is earmarked for primary prevention of mental disorders. So what would happen when a larger budget is dedicated to prevention? And can we optimise the health care system for depression such that larger health gains are generated in an acceptable and economically affordable way? Finding an optimal design for a health care system requires an iterative consensus finding process of defining new health care scenarios and testing these in terms of their acceptability by the pertinent stake holders (panels of patients, clinicians, policy makers and financiers), while at the same time evaluating the incremental cost-effectiveness of these health care scenarios. The computational model can thus be used as a decision support tool to inform debates on resource allocation. The proposed project will produce the following deliverables: 1. Assessment of the population-level cost-effectiveness of the current health care regime with current levels of prevention (relative to a health care scenario where no preventive interventions are offered for depression). 2. Assessment of the costs-effectiveness of a future health care scenario in which prevention of depression plays a more prominent role. This will in part be based on stakeholders meetings with patients, health care providers, policy makers and health insurance companies. The idea is to jointly design an optimal health care regime for depression, which is optimally acceptable, effective and affordable (relative to the current health care system). 3. Development and dissemination of a Costing Tool that helps to inform designers of new preventive interventions about the expected costs of offering that new intervention (to raise awareness about cost-effectiveness). A report will be written about the above topics: options for depression prevention and strategic choices therein; plus recommendations for a research agenda directed at reducing uncertainties in (epidemiological, economic, effectiveness) parameters that were found to have an impact on modelled outcomes. The Trimbos institute is well placed to carry out this project. It has developed the Population-level Acceptability and Cost-Effectiveness (PACE) model for depression with PriceWaterhouseCoopers. In addition, the Trimbos Institute has the relevant networks with stakeholders such as patient groups, health service providers, policy makers and health insurance companies. Two important networks are already in place: the Partnership for Depression Prevention, and the Taskforce of the Multidisciplinary Clinical Guideline for Depressive Disorder; both of which have expressed interest in participating in this project.

Onderwerpen

Kenmerken

Projectnummer:
121020018
Looptijd: 100%
Looptijd: 100 %
2009
2010
Onderdeel van programma:
Projectleider en penvoerder:
Verantwoordelijke organisatie:
Trimbos-instituut