Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Richards DA, Bower P, Chew-Graham C, Gask L, Lovell K, Cape J, Pilling S, Araya R, Kessler D, Barkham M, Bland MJ, Gilbody S, Green C, Lewis G, Manning C, Kontopantelis E, Hill JJ, Hughes-Morley A, Russell A.

Health Technology Assesment Volume 20 Issue 14 , 2016

Collaborative care, that places a care manager in primary care to deliver treatment and coordinate care between GPs and specialists, improved recovery of people with moderate to severe depression. Primary responsibility for prescribing remained with the GP. This large trial found that improvements were modest, but were similar to those found in an evaluation of the Improving Access to Psychological Therapies programme.

The collaborative care model was cost-effective too. Collaborative care cost on average £272.50 per participant and had a cost per quality-adjusted life year (QALY) of £14,248, which is within NHS willingness-to-pay thresholds. Because depression is so common, the implementation of a collaborative care model is likely to require a considerable investment of resources. It would also be necessary to get GPs on board – the researchers found it was difficult for GPs to engage with the collaborative care framework.


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