Kostenstruktur eines Case-Management-Programms in der hausärztlichen Depressionstherapie

Zusammenfassung

Anliegen Case Management für Hausarztpatienten mit Major Depression verbessert die Symptome. Wir stellen die Interventionskosten des Primary Care Monitoring for Depression Trials dar. Methode Aufwands- und Kostenanalyse der Intervention. Ergebnisse Der Case Manager wendete im Jahr 6,3 Stunden, der Hausarzt 3,6 Stunden pro Patient auf. Die Jahreskosten für das Case Management betrugen 277,– € / Patient / Jahr. Schlussfolgerungen Case Management ist wirksam bei akzeptablen Kosten und kleinen Praxen.

Abstract

Objectives Case management by health care assistants in small primary care practices has proven effective in improving depression symptoms in depressive patients. Resource consumption and costs of this intervention have not been evaluated yet. Methods Health care assistants and general practitioners of 15 participating practices were interviewed for intervention-related time expenditures. Intervention costs were based on individual labour costs. Results The annual time spent was 6.3 h per patient for health care assistants and 3.6 h for general practitioners (mean 8.9 patients per practice). The case management caused costs of € 277 per patient and year. Conclusions A telephone-based case management as add-on therapy improves quality of primary care depression therapy while causing only moderate costs for health care providers.

Schlüsselwörter

Case Management - Depression - Primärversorgung - Kostenanalyse - Gesundheitsökonomie

Keywords

case management - depression - primary care - costs - health economy

Literatur

• 1 Ustun T B, Yuso-Mateos J L, Chatterji S et al. Global burden of depressive disorders in the year 2000.  Br J Psychiatry. 2004;  184 386-392
• 2 Luppa M, Heinrich S, Angermeyer M C et al. Cost-of-illness studies of depression: a systematic review.  J Affect Disord. 2007;  98 29-43
• 3 Gunther O H, Friemel S, Bernert S et al. [The burden of depressive disorders in Germany – results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)].  Psychiat Prax. 2007;  34 292-301
• 4 Wang P S, Lane M, Olfson M et al. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication.  Arch Gen Psychiatry. 2005;  62 629-640
• 5 Fernandez A, Haro J M, Martinez-Alonso M et al. Treatment adequacy for anxiety and depressive disorders in six European countries.  Br J Psychiatry. 2007;  190 172-173
• 6 van Steenbergen-Weijenburg K M, van der Feltz-Cornelis C M et al. Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review.  BMC Health Serv Res. 2010;  10 19
• 7 Gensichen J, Korff M von, Peitz M et al. Case management for depression by health care assistants in small primary care practices: a cluster randomized trial.  Ann Intern Med. 2009;  151 369-378
• 8 Gensichen J, Torge M, Peitz M et al. Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT (PRimary care Monitoring for depressive Patient’s Trial) [ISRCTN66386086] – study protocol.  BMC Public Health. 2005;  5 101
• 9 Statistisches Bundesamt .Durchschnittliche Bruttomonatsverdienste in Deutschland. 26.1.2010 http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Content/Statistiken/VerdiensteArbeitskosten/Bruttoverdienste/Tabellen/Content50/LangeReiheD,templateId=renderPrint.psml
• 10 Statistisches Bundesamt .Verdienststrukturerhebung 2006 – Verdienste nach Berufen. Verdienste und Arbeitskosten. 27.8.2008 Wiesbaden: Statistisches Bundesamt. https://www-ec.destatis.de/csp/shop/sfg/bpm.html.cms.cBroker.cls?cmspath=struktur,vollanzeige.csp&ID=1022619
• 11 Statistisches Bundesamt .Pressemitteilung Nr. 160, Lohnnebenkosten im Verhältnis zu den Bruttolöhnen und -gehältern. 22.4.2008 http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Presse/pm/2008/04/PD08__160__624.psml
• 12 Katon W J, Schoenbaum M, Fan M Y et al. Cost-effectiveness of improving primary care treatment of late-life depression.  Arch Gen Psychiatry. 2005;  62 1313-1320
• 13 König H H, Luppa M, Riedel-Heller S. The costs of depression and the cost-effectiveness of treatment.  Psychiat Prax. 2010;  37 213-215
• 14 Simon G E, Katon W J, Lin E H et al. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus.  Arch Gen Psychiatry. 2007;  64 65-72