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Open Access Highly Accessed Research article

Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review

Kirsten M van Steenbergen-Weijenburg12*, Christina M van der Feltz-Cornelis134, Eva K Horn5, Harm WJ van Marwijk67, Aartjan TF Beekman46, Frans FH Rutten2 and Leona Hakkaart-van Roijen2

Author Affiliations

1 Netherlands Institute for Mental Health and Addiction (Trimbos-Institute), Utrecht, The Netherlands

2 Institute for Medical Technology Assessment, Erasmus University Medical Centre, Rotterdam, The Netherlands

3 Institute for Extramural Research, VU University Medical Centre, Amsterdam, The Netherlands

4 Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands

5 Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

6 EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands

7 Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands

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BMC Health Services Research 2010, 10:19  doi:10.1186/1472-6963-10-19

Published: 19 January 2010



The effectiveness of collaborative care for patients with major depressive disorder in primary care has been established. Assessing its cost-effectiveness is important for deciding on implementation. This review therefore evaluates the cost-effectiveness of collaborative care for major depressive disorder in primary care.


A systematic search on economic evaluations of collaborative care was conducted in Pubmed and PsychInfo. Quality of the studies was measured with the Cochrane checklist and the CHEC-list for economic evaluations. Cost-effectiveness and costs per depression-free days were reported.


8 studies were found, involving 4868 patients. The quality of the cost effectiveness studies, according to the CHEC-list, could be improved. Generally, the studies did not include all relevant costs and did not perform sensitivity analysis. Only 4 out of 8 studies reported cost per QALY, 6 out of 8 reported costs per depression-free days. The highest costs per QALY reported were $49,500, the highest costs per depression-free day were $24.


Although studies did not fulfil all criteria of the CHEC-list, collaborative care is a promising intervention and it may be cost-effective. However, to conclude on the cost-effectiveness, depression research should follow economic guidelines to improve the quality of the economic evaluations.