Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial

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Abstract
Background: There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.Aims: To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care.Method: An economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84).Results: The intervention was successful in halving the incidence rate of depression and anxiety at €563 (£412) per recipient and €4367 (£3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least €5000.Conclusions: The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.

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