Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: results of an economic evaluation alongside a pragmatic randomised control trial

J Affect Disord. 2010 Jan;120(1-3):177-87. doi: 10.1016/j.jad.2009.04.012.


Background: Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC).

Methods: We conducted an economic evaluation from a societal perspective. Quality-adjusted life years (QALYs) and resource use were measured by the EuroQol and cost diaries, respectively. Uncertainty was estimated by 95% confidence intervals, cost-effectiveness planes and acceptability curves. Sensitivity analyses and ancillary analyses based on preplanned subgroups were performed.

Results: No statistically significant differences in costs or QALYs were observed. The mean incremental cost per QALY was -euro 7356 and located in the southeast quadrant of the cost-effectiveness plane, whereby the intervention was slightly more effective and less costly. For willingness-to-pay (lambda) thresholds from euro 0 to euro 100,000, the probability of MISS being cost-effective was 0.58-0.90. For the preplanned subgroup of patients diagnosed with stress-related mental disorders, the incremental ratio was -euro 28,278, again in the southeast quadrant. Corresponding probabilities were 0.92 or greater.

Limitations: Non-significant findings may be related to poor implementation of the MISS intervention and low power. Also, work-presenteeism and unpaid labor were not measured.

Conclusions: The minimal intervention was not cost-effective compared to usual care for a heterogeneous patient population. Therefore, we do not recommend widespread implementation. However, the intervention may be cost-effective for the subgroup stress-related mental disorders. This finding should be confirmed before implementation for this subgroup is considered.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antidepressive Agents / economics*
  • Antidepressive Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Depressive Disorder, Major* / drug therapy
  • Depressive Disorder, Major* / economics
  • Depressive Disorder, Major* / etiology
  • Economics
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care / economics*
  • Sick Leave*
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Young Adult


  • Antidepressive Agents