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

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
• major depressive disorder
• health-economic modeling
• depression

Article highlights

• DepMod is a methodologically sound model that can be used to examine the cost-effectiveness and budget impact of a user-defined package of preventive interventions and psychological and pharmacological treatments of depression

• DepMod can be used for various interventions (e.g., medication, cognitive behavior therapy, et cetera) in a relatively easy and accessible way.

• The transition rates between health states were derived from NEMESIS-2, a large psychiatric cohort study of adults (18 – 65 years) in the Netherlands, but DepMod permits user-defined adaption of its epidemiology for use in other geographies or age groups.

• For illustrative purposes, DepMod was used to assess the cost-effectiveness of scaling up preventive interventions for treating people with subclinical depression in the Netherlands, 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.

• DepMod is freely available for academic purposes upon request by the authors.

Authors contributions

Overall project coordination: JL, FS. Writing of manuscript: JL, BW. Critical appraisal of manuscript: HGR, JS, AM, RS, MDB, PC, FS. All authors have read and approved the manuscript.

Acknowledgments

We acknowledge dr. Talitha Feenstra, prof. dr. Claudi Bockting, and the taskforce for the development of the Dutch Multidisciplinary Guideline for Depression for constructive comments on early drafts of this manuscript.

Availability of data and materials

The model (DepMod) is freely available upon request at the authors.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Ethics approval and consent to participate

Not applicable, the study did not involve human subjects.

Additional information

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.