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Ruth M.A. van Nispen, Hilde PA van der Aa, Ger Van Rens; Cost-effectiveness of stepped-care implemented in low vision rehabilitation to reduce depression and anxiety in vision impaired older adults. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5185.
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© ARVO (1962-2015); The Authors (2016-present)
One in three vision impaired older adults has subclinical symptoms of depression and/or anxiety and is at risk of full blown psychiatric disorders. This puts a burden on quality of life of patients and on societal resources. Recently our stepped-care program proved to be effective in preventing development of disorders (relative risk: 0.63), however, evidence of cost-effectiveness is not yet available. We performed an economic evaluation alongside a multicenter randomized clinical trial to investigate the cost-effectiveness from a societal perspective of this new intervention to prevent depressive and/or anxiety disorders.
Vision impaired adults (>50 years) having subclinical symptoms of depression and/or anxiety (mean age 74, 70% women, 46% macular degeneration) from 17 Dutch and Belgian low vision rehabilitation centers were randomized to stepped-care (n=131) or usual care (n=134). If symptoms persisted as assessed every three months, patients moved to the next more intensive and costly treatment step: (1) watchful waiting, (2) guided self-help based on cognitive behavioral therapy, (3) problem solving treatment and (4) referral to the general practitioner. Primary and secondary outcomes were, respectively, incidence of a depressive and/or anxiety disorder and quality adjusted life years (QALYs). Clinical outcomes and resource use was measured with telephone interviews by blind assessors over 24 months and valued using standard direct and indirect (friction method) healthcare costs.
Differences in the main clinical outcome was in favor of stepped care (absolute risk difference -0.17, p=0.01); no significant difference in QALYs was found. Mean intervention costs were $285 per person. Total costs were $23,733 in the intervention and $24,800 in the usual care group (mean difference: $1,067 95% confidence interval: -7,430 to 5,295). Cost-effectiveness planes indicated that stepped-care was more effective and cheaper than usual care.
As the intervention was found to be cost-effective from a societal perspective, main findings introduce possibilities for implementing stepped-care in the countries of origin. However, cost-effectiveness is questionable when taking QALYs or the human capital approach for indirect costs into account and needs further consideration in decision making.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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