Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review

PLoS One. 2015 May 19;10(5):e0123078. doi: 10.1371/journal.pone.0123078. eCollection 2015.


Background: For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care.

Purpose: To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care.

Methods: A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC) list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP).

Results: In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562.

Conclusion: Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Cooperative Behavior*
  • Cost-Benefit Analysis*
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy*
  • Humans
  • Primary Health Care*
  • Quality-Adjusted Life Years

Grant support

This study was funded by the German Federal Ministry of Education and Research (grant numbers: 01KQ1002B, 01GY1142 and 01GY55A) within the projects “psychenet: Hamburg Network for Mental Health," “GermanIMPACT” and “AgeMooDe," and by the Federal Ministry of Health (grant number: II A 5–2513 FSB 014) within the project “AgeMooDe-Synergie." The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.