JMIR Publications

ABSTRACT

Background:

Major depressive disorder (MDD) is a leading contributor to the global burden of disease, associated with substantial impairment in daily functioning and reduced quality of life for the individual and considerable societal costs. Farmers constitute a particularly vulnerable population, facing an elevated depression risk due to occupational, financial, and social stressors, and simultaneously encountering considerable barriers to mental health care. Personalized telephone coaching offers a promising solution for indicative prevention in this group. However, despite the evidence on its clinical effectiveness, the cost-effectiveness and cost-utility of telephone coaching for preventing MDD remain insufficiently examined.

Objective:

This economic evaluation aimed to evaluate the cost-effectiveness and cost-utility of a personalized telephone coaching (IG) provided by psychologists compared to treatment-as-usual plus informational material (TAU+) in farmers from a societal and social insurance perspective within a time horizon of 18 months.

Methods:

An economic evaluation was performed alongside a pragmatic randomized controlled trial (RCT). Health service use, patient and family expenses, and productivity costs were assessed with the adapted German version of the self-report questionnaire TiC-P (Trimbos Institute and Institute of Medical Technology Questionnaire for Costs Associated with Psychiatric Illness). Outcomes were measured in terms of depression symptom-free status (Quick Inventory of Depressive Symptomology – Self-Report (QIDS-SR16)<6) and quality-adjusted life years (QALYs; Assessment of Quality of Life (AQoL-8D)). All assessments were conducted web-based. A cost-effectiveness (CEA) and cost-utility analysis (CUA) were performed from the societal and social insurance perspective. Analyses followed the intention-to-treat principle with multiple imputation. Uncertainty around incremental cost-effectiveness ratio (ICER) estimates was characterized using bootstrapped seemingly unrelated regression equations (2,500 simulations). Sensitivity analyses assessed the robustness of the findings.

Results:

In total, 314 participants were included in the RCT. From a societal perspective, the IG produced a greater number of participants achieving depression symptom-free status (ΔE=0.11, 95%CI –0.01 to 0.23) compared to TAU+ at higher costs (ΔC=€663, 95%CI 2820 to 4052; €1=US $1.12 as of 2019). The probability of the IG being cost-effective was 37% at a willingness-to-pay (WTP) threshold of €0 per depression symptom-free status and QALY gained, rising to 63% when applying a societal WTP of €20,000 per QALY gained (38% from a social insurance perspective). Analyses conducted from the social insurance perspective, as well as sensitivity analyses, indicated the dominance of TAU+ over the IG, with intervention costs as the primary cost driver.

Conclusions:

Findings suggest that MDD prevention via personalized telephone coaching yield larger effects, albeit accompanied by higher costs from both a societal and social insurance perspective within the observed time horizon. These results inform evidence-based decision-making on cost-effective MDD prevention in occupational groups, and highlight the need for comparative trials with alternative approaches. Clinical Trial: German Clinical Trial Registration: DRKS00015655. Registered on October 2, 2018.