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DOI: 10.1055/s-0034-1387572
Kosteneffektivität der Depressionsbehandlung im Alter
Eine systematische LiteraturübersichtCost-Effectiveness of the Treatment of Depression in Old AgeA Systematic ReviewPublication History
Publication Date:
23 June 2015 (online)
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Zusammenfassung
Anliegen: Systematische Darstellung der Evidenz zur Kosteneffektivität der Behandlung von Depression im Alter.
Methode: Systematische Suche in elektronischen Datenbanken.
Ergebnisse: Neun Arbeiten wurden eingeschlossen, darunter Studien mit psychologischer (n = 3), pharmakologischer Therapie (n = 1) und integrierten Versorgungsprogrammen (n = 5). Die Ergebnisse der eingeschlossenen Studien variieren stark.
Schlussfolgerungen: Die gefundenen Studien sind sehr selektiv und erlauben insbesondere für die verbreitete und empfohlene Psychopharmakotherapie keine verallgemeinernden Schlussfolgerungen. Bei psychologischen Interventionen und integrierten Versorgungsprogrammen variiert die Kosteneffektivität je nach konkreter Ausgestaltung der Intervention.
Abstract
Objective: To conduct a systematic literature review of cost-effectiveness studies evaluating the treatment of depression in old age.
Methods: Systematic literature search in electronic databases in March 2014.
Results: Nine studies were included in the review. They were conducted in the Netherlands, the United Kingdom and the United States. The studies investigated psychological interventions (N = 3), pharmacotherapy (N = 1), and integrated care models (N = 5). The results varied greatly.
Conclusion: The variation of the results in the included studies does not permit generalized conclusions, especially not for the widespread and recommended pharmacotherapy. Cost-effectiveness of psychological interventions and integrated care programs differed depending on the details of the program designs.
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Literatur
- 1 Luppa M, Sikorski C, Luck T et al. Age-and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis. J Affect Disorders 2012; 136: 212-221
- 2 Stuck AE, Walthert JM, Nikolaus T et al. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999; 48: 445-469
- 3 Unützer J, Patrick DL, Diehr P et al. Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. Int Psychogeriatr 2000; 12: 15-33
- 4 Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disorders 2002; 72: 227-236
- 5 Luppa M, Heinrich S, Matschinger H et al. Direct costs associated with depression in old age in Germany. J Affect Disorders 2008; 105: 195-204
- 6 Lacruz ME, Emeny RT, Haefner S et al. Relation between depressed mood, somatic comorbidities and health service utilisation in older adults: results from the KORA-Age study. Age Ageing 2012; 41: 183-190
- 7 Busch MA, Neuner B, Aichberger MC et al. Depressive Symptomatik und Inanspruchnahme von Gesundheits- und Pflegeleistungen bei Personen im Alter ab 50 Jahren in Deutschland. Psychiat Prax 2013; 40: 214-219
- 8 Bock J-O, Luppa M, Brettschneider C et al. Impact of Depression on Health Care Utilization and Costs among Multimorbid Patients–Results from the MultiCare Cohort Study. PloS one 2014; 9: e91973
- 9 Alexopoulos GS, Buckwalter K, Olin J et al. Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry 2002; 52: 543-558
- 10 Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 2003; 58: M249-M265
- 11 Luppa M, Sikorski C, Motzek T et al. Health service utilization and costs of depressive symptoms in late life – a systematic review. Curr Pharm Des 2012; 18: 5936-5957
- 12 Anderson DN. Treating depression in old age: the reasons to be positive. Age Ageing 2001; 30: 13-17
- 13 Crawford M, Prince M, Menezes P et al. The recognition and treatment of depression in older people in primary care. Int J Geriatr Psychiatry 1998; 13: 172-176
- 14 DGPPN, BÄK, KBV et al. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung. 1.. Aufl. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF; 2009
- 15 Sikorski C, Luppa M, Riedel-Heller S. Innovative Versorgungsansätze zur Behandlung von Depression. In: Klauber J, Günster C, Gerste B, et al., Hrsg. Versorgungs-Report 2013/2014: Schwerpunkt: Depression. Stuttgart: Schattauer Verlag; 2014: 77-98
- 16 König H-H, Luppa M, Riedel-Heller S. Die Kosten der Depression und die Wirtschaftlichkeit ihrer Behandlung. Psychiat Prax 2010; 37: 213-215
- 17 Graf v d Schulenburg J-M. Die Entwicklung der Gesundheitsökonomie und ihre methodischen Ansätze. In: Schöffski O, Graf v d Schulenburg J-M, Hrsg. Gesundheitsökonomische Evaluationen. Heidelberg, Dordrecht, London, New York: Springer; 2012: 13-21
- 18 Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000; 342: 1887-1892
- 19 Barton S. Which clinical studies provide the best evidence?: The best RCT still trumps the best observational study. BMJ 2000; 321: 255-256
- 20 Organisation for Economic Co-operation and Development. PPPs and exchange rates. Im Internet: http://stats.oecd.org/Index.aspx?DataSetCode=SNA_Table4 (Stand: 09.02.2015)
- 21 Aziz M, Mehringer AM, Mozurkewich E et al. Cost-utility of 2 maintenance treatments for older adults with depression who responded to a course of electroconvulsive therapy: results from a decision analytic model. Can J Psychiatry 2005; 50: 389-397
- 22 McDonald WM, Phillips VL, Figiel GS et al. Cost-effective maintenance treatment of resistant geriatric depression. Psychiatr Ann 1998; 28: 47-52
- 23 Banerjee S, Hellier J, Romeo R et al. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial – a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess 2013; 17: 1-43
- 24 Bosmans J, de Bruijne M, van Hout H et al. Cost-effectiveness of a disease management program for major depression in elderly primary care patients. J Gen Intern Med 2006; 21: 1020-1026
- 25 Bosmans JE, van Schaik DJ, Heymans MW et al. Cost-effectiveness of interpersonal psychotherapy for elderly primary care patients with major depression. Int J Technol Assess Health Care 2007; 23: 480-487
- 26 Holman AJ, Serfaty MA, Leurent BE et al. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care. BMC Health Serv Res 2011; 11: 33
- 27 Jonkers CC, Lamers F, Evers SM et al. Economic evaluation of a minimal psychological intervention in chronically ill elderly patients with minor or mild to moderate depression: a randomized trial (the DELTA-study). Int J Technol Assess Health Care 2009; 25: 497-504
- 28 Katon W, Unutzer J, Fan MY et al. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes care 2006; 29: 265-270
- 29 Katon WJ, 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
- 30 Wiley-Exley E, Domino ME, Maxwell J et al. Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study. J Ment Health Policy Econ 2009; 12: 205-213
- 31 van der Weele GM, de Waal MW, van den Hout WB et al. Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial. Age Ageing 2012; 41: 482-488
- 32 van Steenbergen-Weijenburg KM, van der Feltz-Cornelis CM, Horn EK 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
- 33 Salzman C, Wong E, Wright BC. Drug and ECT treatment of depression in the elderly, 1996–2001: a literature review. Biol Psychiatry 2002; 52: 265-284
- 34 Alexopoulos GS. Depression in the elderly. Lancet 2005; 365: 1961-1970
- 35 Briggs A. Economic evaluation and clinical trials: size matters: The need for greater power in cost analyses poses an ethical dilemma. BMJ 2000; 321: 1362-1363
- 36 Goossens ME, Mölken MP, Vlaeyen JW et al. The cost diary: a method to measure direct and indirect costs in cost-effectiveness research. J Clin Epidemiol 2000; 53: 688-695
- 37 Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev 2006; 63: 217-235
- 38 Heinrich S, Deister A, Birker T et al. Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records. Psychiatry Res 2011; 185: 261-268
- 39 Zentner N, Baumgartner I, Becker T et al. Kosten medizinischer Leistungen bei Menschen mit schweren psychischen Erkrankungen: Selbstbericht vs. Kostenträgerangaben. Psychiat Prax 2012; 39: 122-128
- 40 Wernher I, Bjerregaard F, Tinsel I et al. Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial. Trials 2014; 15: 351
- 41 O’Connor EA, Whitlock EP, Gaynes B et al. Screening for depression in adults and older adults in primary care. Rockville, Maryland: Agency for Healthcare Research and Quality; 2009