Design of a health-economic Markov model to assess cost-effectiveness and budget impact of the prevention and treatment of depressive disorder

Joran Lokkerbol; Ben Wijnen; Henricus G Ruhe; Jan Spijker; Arshia Morad; Robert Schoevers; Marrit K de Boer; Pim Cuijpers; Filip Smit

doi:10.1080/14737167.2021.1844566

Design of a health-economic Markov model to assess cost-effectiveness and budget impact of the prevention and treatment of depressive disorder

Expert Rev Pharmacoecon Outcomes Res. 2021 Oct;21(5):1031-1042. doi: 10.1080/14737167.2021.1844566. Epub 2020 Nov 23.

Authors

Joran Lokkerbol¹, Ben Wijnen^{1

2}, Henricus G Ruhe^{3

4

5}, Jan Spijker^{6

7}, Arshia Morad⁸, Robert Schoevers^{3

9}, Marrit K de Boer³, Pim Cuijpers^{10

11}, Filip Smit^{1

10

11}

Affiliations

¹ Centre for Economic Evaluation and Machine Learning, Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.
² Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands.
³ Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁴ Radboudumc, Department of Psychiatry, Radboud University of Nijmegen, Nijmegen, The Netherlands.
⁵ Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.
⁶ Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
⁷ Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands.
⁸ School of Psychology, The University of Sydney, New South Wales, Australia.
⁹ Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands.
¹⁰ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands.
¹¹ Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Academic Medical Centers Amsterdam, Location VUmc, Amsterdam, The Netherlands.

Abstract

Background/objective: To describe the design of 'DepMod,' a health-economic Markov model for assessing cost-effectiveness and budget impact of user-defined preventive interventions and treatments in depressive disorders.Methods: DepMod has an epidemiological layer describing how a cohort of people can transition between health states (sub-threshold depression, first episode of mild, moderate or severe depression (partial) remission, recurrence, death). Superimposed on the epidemiological layer, DepMod has an intervention layer consisting of a reference scenario and alternative scenario comparing the effectiveness and cost-effectiveness of a user-defined package of preventive interventions and psychological and pharmacological treatments of depression. Results are presented in terms of quality-adjusted life years (QALYs) gained and healthcare expenditure. Costs and effects can be modeled over 5 years and are subjected to probabilistic sensitivity analysis.Results: DepMod was used to assess the cost-effectiveness of scaling up preventive interventions for treating people with subclinical depression, which showed that there is an 82% probability that scaling up prevention is cost-effective given a willingness-to-pay threshold of €20,000 per QALY.Conclusion: DepMod is a Markov model that assesses the cost-utility and budget impact of different healthcare packages aimed at preventing and treating depression and is freely available for academic purposes upon request at the authors.

Keywords: Cost-effectiveness; budget impact; depression; health-economic modeling; major depressive disorder.

MeSH terms

Adult
Budgets
Cost-Benefit Analysis
Depressive Disorder / economics
Depressive Disorder / prevention & control
Depressive Disorder / therapy*
Economics, Medical
Health Care Costs / statistics & numerical data*
Humans
Markov Chains
Models, Economic*
Quality-Adjusted Life Years*
Severity of Illness Index

Grants and funding

Development of DepMod was financially supported by The Netherlands Organisation for Health Research and Development (ZonMW), grant 50-50110-96-634. An earlier version was supported by the Netherlands’ Ministry of Health (VWS). Joran Lokkerbol was supported by The Netherlands Organisation for Health Research and Development (ZonMw) Mental Healthcare Fellowship, grant #636320003.