Article type
Year
Abstract
Background: Depression will soon become the second largest cause of disability. Clinicians and policy makers have an ethical imperative to ensure that treatment is both effective AND efficient. The vast majority of depression is (often suboptimally) managed in primary care, where intervetnions should be targeted. A number of competing organisational and educational strategies - such as guidelines, clinician education and case management - have been proposed. Systematic reviews of cost effectiveness data are conceptually difficult, since primary studies use different methods; measure different costs and currencies; adopt differing perspectives; use different periods of follow up; and use different units of effectiveness (including Quality Adjusted Life Years QALYs). One method that has been proposed to address these problems is the permutation matrix [1].
Objective: To summarise cost effectiveness data in a way that is both rigorous and understandable using systematic review methods, including the permutation matrix.
Methods: We identified eleven full randomised economic evaluations. Cost and consequence were standardised to UK\xa3 and US$ and incremental cost effectiveness ratios (ICERs) were visually summarised using a permutation matrix.
Results: A near uniform finding was that the interventions were clinically effective, but were associated with increased costs. When considering primary care depression treatment costs alone, ICER estimates ranged from $13 to $24 per depression free day. When measuring quality adjusted life years (QALYs) estimates ranged from $15,463 per QALY for a nurse delivered case management approach, to $36,434 per QALY for a complex intervention to enhance medication management. Educational interventions alone were associated with increased cost and no clinical benefit. A permutation matrix presented a conceptual and visual summary of these complex data.
Conclusions: Improved outcomes through depression management programmes can be expected, but are associated with increased cost and will require investment. Decision makers will find this evidence synthesis useful in planning care and in setting priorities. These data have not previously been synthesised in any systematic way, and the permutation matrix is a potentially useful method for summarising and presenting these complex data.
1. Nixon J, Khan KS, Kleijnen J. Summarising economic evaluations in systematic reviews: a new approach. BMJ 2001;322:1596-8.
Objective: To summarise cost effectiveness data in a way that is both rigorous and understandable using systematic review methods, including the permutation matrix.
Methods: We identified eleven full randomised economic evaluations. Cost and consequence were standardised to UK\xa3 and US$ and incremental cost effectiveness ratios (ICERs) were visually summarised using a permutation matrix.
Results: A near uniform finding was that the interventions were clinically effective, but were associated with increased costs. When considering primary care depression treatment costs alone, ICER estimates ranged from $13 to $24 per depression free day. When measuring quality adjusted life years (QALYs) estimates ranged from $15,463 per QALY for a nurse delivered case management approach, to $36,434 per QALY for a complex intervention to enhance medication management. Educational interventions alone were associated with increased cost and no clinical benefit. A permutation matrix presented a conceptual and visual summary of these complex data.
Conclusions: Improved outcomes through depression management programmes can be expected, but are associated with increased cost and will require investment. Decision makers will find this evidence synthesis useful in planning care and in setting priorities. These data have not previously been synthesised in any systematic way, and the permutation matrix is a potentially useful method for summarising and presenting these complex data.
1. Nixon J, Khan KS, Kleijnen J. Summarising economic evaluations in systematic reviews: a new approach. BMJ 2001;322:1596-8.