Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial
Open accessAbstract
BACKGROUND: Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. METHODS: An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. RESULTS: There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. CONCLUSIONS: PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. TRIAL REGISTRATION: Nederlands Trial Register ISRCTN51021015.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The two studies found showed fewer GP contacts after short-term psychological interventions and higher satisfaction among GPs.
“The two studies we found [18,19] showed fewer GP contacts after short-term psychological interventions and higher satisfaction among GPs.”
From Healthcare utilization in general practice before and after psychological treatment: A follow-up data linkage study in primary care (2014) · cites this paper as [18]
Table 1 (Methods > Cost measures; page unavailable) reports fewer GP contacts over nine months in the problem-solving treatment group than in usual care (4.1 versus 4.8 on average), though the difference was not statistically significant. The paper reports one trial, and the passages on outcomes and health care utilization do not report GP satisfaction; this source therefore does not support the claim that both studies found higher satisfaction among GPs. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Multiple Imputation for Nonresponse in Surveys
Rubin, D. B. (1987) · Wiley Series in Probability and Statistics · doi:10.1002/9780470316696 · Cited by 20,701 · see citing works
EuroQol: a new facility for the measurement of health-related quality of life
(1990) · Health Policy · doi:10.1016/0168-8510(90)90421-9 · Cited by 15,736 · see citing works
Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies
Wittchen, H.-U., & Jacobi, F. (2005) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2005.04.012 · Cited by 1,503 · cited 2× · see citing works
“Background Mental health problems are prevalent, with depression and anxiety being most common [1-3].”
BackgroundCost of Lost Productive Work Time Among US Workers With Depression
Stewart, W. F. (2003) · JAMA · doi:10.1001/jama.289.23.3135 · Cited by 1,421 · see citing works
The Economic Burden of Depression in the United States: How Did It Change Between 1990 and 2000?
Greenberg, P. E., Kessler, R. C., Birnbaum, H. G., Leong, S. A., Lowe, S. W., Berglund, P. A., & Corey-Lisle, P. K. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n1211 · Cited by 1,280 · see citing works
The economic burden of anxiety disorders in the 1990s
Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R. T., Ballenger, J. C., & Fyer, A. J. (1999) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v60n0702 · Cited by 1,242 · cited 1× · see citing works
“Moreover, mental health problems are associated with high health care costs and lost productivity costs, thus causing a huge economic burden as well [4-6].”
BackgroundCost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions
Fenwick, E. A. L., OʼBrien, B. J., & Briggs, A. H. (2004) · Health Economics · doi:10.1002/hec.903 · Cited by 946 · see citing works
Ormel, E. A. J. (1995) · PsycEXTRA Dataset · doi:10.1037/e536912011-072 · Cited by 706 · see citing works
Black, W. C. (1990) · Medical Decision Making · doi:10.1177/0272989x9001000308 · Cited by 578 · see citing works
[Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff].
Lamers, L. M., Stalmeier, P. F. M., McDonnell, J., Krabbe, P. F. M., & Busschbach, J. J. V. (2005) · PubMed · Cited by 574 · see citing works
Mynors‐Wallis, L., Gath, D. H., Lloyd-Thomas, A. R., & Tomlinson, D. (1995) · BMJ · doi:10.1136/bmj.310.6977.441 · Cited by 491 · see citing works
Missing Data, Imputation, and the Bootstrap
Efron, B. (1994) · Journal of the American Statistical Association · doi:10.1080/01621459.1994.10476768 · Cited by 471 · see citing works
The General Health Questionnaire
Jackson, C. A. (2006) · Occupational Medicine · doi:10.1093/occmed/kql169 · Cited by 470 · see citing works
Mynors‐Wallis, L. (2000) · BMJ · doi:10.1136/bmj.320.7226.26 · Cited by 451 · see citing works
Patients' preferences in the treatment of depressive disorder in primary care
van Schaik, D. J. F., Klijn, A. F. J., van Hout, H. P. J., van Marwijk, H. W. J., Beekman, A. T. F., de Haan, M., & van Dyck, R. (2004) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2003.12.001 · Cited by 428 · see citing works
Priest, R. G., Vize, C., Roberts, A., Roberts, M., & Tylee, A. (1996) · BMJ · doi:10.1136/bmj.313.7061.858 · Cited by 385 · see citing works
Oostenbrink, J. B., Koopmanschap, M. A., & Rutten, F. (2002) · PharmacoEconomics · doi:10.2165/00019053-200220070-00002 · Cited by 347 · see citing works
Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-38 · Cited by 283 · see citing works
Occurrence, recognition, and outcome of psychological disorders in primary care
Tiemens, B. G., Ormel, J., & Simon, G. E. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.5.636 · Cited by 243 · see citing works
Goetzel, R. Z., Ozminkowski, R. J., Sederer, L. I., & Mark, T. L. (2002) · Journal of Occupational and Environmental Medicine · doi:10.1097/00043764-200204000-00012 · Cited by 230 · see citing works
Dowrick, C., Dunn, G., Ayuso-Mateos, J. L., Dalgard, O. S., Page, H., Lehtinen, V., Casey, P., Wilkinson, C., Vazquez-Barquero, J. L., & Wilkinson, G. (2000) · BMJ · doi:10.1136/bmj.321.7274.1450 · Cited by 228 · see citing works
Economic evaluation and clinical trials: size matters
Briggs, A. H. (2000) · BMJ · doi:10.1136/bmj.321.7273.1362 · Cited by 224 · see citing works
The treatment of depression: prescribing patterns of antidepressants in primary care in the UK
Donoghue, J. M., & Tylee, A. (1996) · British Journal of Psychiatry · doi:10.1192/bjp.168.2.164 · Cited by 209 · see citing works
The burden of depression and anxiety in general medicine.
Lecrubier, Y. (2001) · PubMed · Cited by 207 · see citing works
Mynors‐Wallis, L., Davies, I., Gray, A., Barbour, F., & Gath, D. H. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.170.2.113 · Cited by 167 · see citing works
Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data
Burton, A., Billingham, L. J., & Bryan, S. (2007) · Clinical Trials · doi:10.1177/1740774507076914 · Cited by 137 · see citing works
van Loo, J. B., & Cörvers, F. (2004) · Research Publications (Maastricht University) · Cited by 75 · see citing works
The workload of GPs: consultations of patients with psychological and somatic problems compared.
Zantinge, E. M., Verhaak, P. F. M., Kerssens, J. J., & Bensing, J. M. (2005) · Europe PMC (PubMed Central) · Cited by 74 · see citing works
Psychosocial interventions delivered by general practitioners
Huibers, M. J. H., Beurskens, A. J. H. M., Bleijenberg, G., & van Schayck, O. C. P. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003494 · Cited by 73 · see citing works
Kendrick, T., Simons, L., Mynors‐Wallis, L., Gray, A., Lathlean, J., Pickering, R. M., Harris, S. P., Rivero‐Arias, O., Gerard, K., & Thompson, C. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.105.012435 · Cited by 68 · see citing works
The treatment of common mental health problems in general practice
The MaGPIe Research Group (2005) · Family Practice · doi:10.1093/fampra/cmi097 · Cited by 54 · see citing works
NHG-Standaard Depressieve stoornis (depressie)
van Marwijk, H., Grundmeijer, H. G. L. M., Bijl, D., Gelderen, M. G. V., Haan, M. D., van Weel-Baumgarten, E. M., Burgers, J. S., Boukes, F. S., & Romeijnders, A. C. M. (2009) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-6614-9_28 · Cited by 38 · see citing works
Primary care patients with mental health problems: outcome of a randomised clinical trial
Schreuders, B., van Marwijk, H., Smit, J. H., Rijmen, F., Stalman, W. A. B., & van Oppen, P. (2007) · British Journal of General Practice · doi:10.3399/096016407782317829 · Cited by 38 · see citing works
Self-citationSchreuders, B., van Oppen, P., van Marwijk, H., Smit, J. H., & Stalman, W. A. B. (2005) · BMC Family Practice · doi:10.1186/1471-2296-6-42 · Cited by 23 · see citing works
Self-citation
Flagged first, then by citations
1 of the 37 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Biesheuvel-Leliefeld, K. E. M., Kok, G. D., Bockting, C. L. H., Cuijpers, P., Hollon, S. D., van Marwijk, H. W. J., & Smit, F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.016 · Cited by 175 · see citing works
Tricco, A. C., Antony, J., Ivers, N. M., Ashoor, H. M., Khan, P. A., Blondal, E., Ghassemi, M., MacDonald, H. R., Chen, M. H., Ezer, L. K., et al. (2014) · Canadian Medical Association Journal · doi:10.1503/cmaj.140289 · Cited by 164 · see citing works
van Dijk, S. E. M., Pols, A. D., Adriaanse, M. C., Bosmans, J. E., Elders, P. J. M., van Marwijk, H., & van Tulder, M. W. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-128 · Cited by 43 · see citing works
Self-citationLee, H., Yoon, J. Y., Lim, Y., Jung, H., Kim, S., Yoo, Y., Kim, Y., Ahn, J., & Park, H. (2014) · Age and Ageing · doi:10.1093/ageing/afu201 · Cited by 41 · see citing works
Economic Evaluation of Mental Health Interventions: A Guide to Costing Approaches
Shearer, J., McCrone, P., & Romeo, R. (2016) · PharmacoEconomics · doi:10.1007/s40273-016-0390-3 · Cited by 34 · see citing works
Pols, A. D., van Dijk, S. E., Bosmans, J. E., Hoekstra, T., van Marwijk, H. W. J., van Tulder, M. W., & Adriaanse, M. C. (2017) · PLOS ONE · doi:10.1371/journal.pone.0181023 · Cited by 31 · see citing works
Self-citationCaring for family caregivers: An analysis of a family-centered intervention
Ferré‐Grau, C., Sevilla-Casado, M., Buera, D. C., Fortuño, M. L., Montesó‐Curto, P., & Berenguer, M. (2014) · Revista da Escola de Enfermagem da USP · doi:10.1590/s0080-623420140000600013 · Cited by 24 · see citing works
Nursing psychotherapeutic interventions: a review of clinical studies
Sampaio, F. M. C., Sequeira, C., & Lluch‐Canut, T. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.12808 · Cited by 24 · see citing works
The Estimation of Utility Weights in Cost-Utility Analysis for Mental Disorders: A Systematic Review
Sonntag, M., König, H., & Konnopka, A. (2013) · PharmacoEconomics · doi:10.1007/s40273-013-0107-9 · Cited by 23 · see citing works
Scodari, B. T., Chacko, S. M., Matsumura, R., & Jacobson, N. C. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.08.004 · Cited by 20 · see citing works
Salcedo, V. V., Terrez, B. E. V., Caraveo-Anduaga, J. J., Gonzalez-Olvera, J. J., Díaz‐Anzaldúa, A., Cortés-Sotres, J., & Pérez-Ávila, M. (2017) · Primary Health Care Research & Development · doi:10.1017/s1463423617000512 · Cited by 16 · see citing works
Tosh, J. C., Kearns, B., Brennan, A., Parry, G. D., Ricketts, T., Saxon, D. H., Foster, A., Thake, A., Chambers, E., & Hutten, R. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-150 · Cited by 11 · see citing works
Maljanen, T., Härkänen, T., Virtala, E. T., Lindfors, O., Tillman, P., & Knekt, P. (2014) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2014.43030 · Cited by 7 · see citing works
Prins, M. A., Verhaak, P. F. M., Smit, D., & Verheij, R. A. (2014) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2014.953312 · Cited by 5 · see citing works
“The two studies we found [18,19] showed fewer GP contacts after short-term psychological interventions and higher satisfaction among GPs.”
BackgroundFajarini, M., Sung, C., Lin, Y.-S., Su, P.-Y., Chen, R., Chang, L., Chiang, K., & Chou, K. (2026) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2026.105365 · Cited by 2 · see citing works
Health Policy and Economic Aspects of Late-Life Depression Prevention
Singh, A., & Okereke, O. I. (2015) · Springer eBooks · doi:10.1007/978-3-319-16045-0_9
- Authors
- Bosmans, J. E., Schreuders, B., van Marwijk, H. W., Smit, J. H., van Oppen, P., & van Tulder, M. W.
- Affiliations
- Amsterdam Public Health (NL)
- Corresponding author
- Bosmans, Judith E
- ORCID
- Bosmans, Judith E
- Venue
- BMC Family Practice
- Published
- 2012-10-10
- Volume
- 13
- Issue
- 1
- Pages
- 98-98
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC3515338
- OpenAlex
- W2154070425
- Cited by
- 16
- References
- 37
- Citations by year
- 2026: 1 · 2023: 1 · 2017: 2 · 2016: 1 · 2015: 2 · 2014: 6 · 2013: 3
- FWCI
- 8.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (acceptedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- ZonMw
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › Speech and Hearing › Problem Solving Skills Development
- Keywords
- problem-solving therapy, cost-effectiveness, mental illness, psychiatric nurses, primary care, usual care, general practitioners, anxiety, depression, quality-adjusted life years, resource utilization (health care), economic evaluation
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Depression, Female, Humans, Male, Middle Aged, Primary Health Care, Problem Solving, Psychotherapy, Brief, Health Care Costs, Quality-Adjusted Life Years, Practice Patterns, Nurses'
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
