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    Economic evaluation of prevention. Modelling the cost-effectiveness of increasing alcohol taxes and of prevention of major depression

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    Authors
    van Baal PHM
    van den Berg M
    Tariq L
    Hoogenveen RT
    Schoemaker CG
    Schuit AJ
    de Wit GA
    Type
    Report
    Language
    en
    
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    Title
    Economic evaluation of prevention. Modelling the cost-effectiveness of increasing alcohol taxes and of prevention of major depression
    Translated Title
    Economische evaluatie van preventie. Modelleringstudies naar de kosteneffectiviteit van accijnsverhogingen op alcohol en van depressiepreventie
    Publiekssamenvatting
    Accijnsverhogingen op alcohol en een vroegtijdige opsporing van depressies leveren veel gezondheidswinst op tegen relatief lage kosten. De opsporing van dit stadium van een depressie door de huisarts, gevolgd door minimale contact psychotherapie (MCP) levert naar verwachting 13.000 gezonde levensjaren op en kost op termijn gemiddeld euro 6.800,- per gewonnen gezond levensjaar. De geplande accijnsverhoging voor 2009 levert naar verwachting 13.000 gezonde levensjaren op en kost op termijn gemiddeld euro 5.100,- per gewonnen gezond levensjaar. Beide maatregelen zijn daarmee kosteneffectieve interventies.
    Uit eerder onderzoek bleek dat beide interventies effectief zijn in het voorkomen van ziekte, alleen was nog weinig bekend over de kosteneffectiviteit. Daarom is in dit rapport met behulp van modelberekeningen de mogelijke kosteneffectiviteit in de Nederlandse context onderzocht. Hierbij is uitgegaan van grootschalige implementatie van de maatregelen. De gezondheidseffecten zijn uitgedrukt in voor kwaliteit gecorrigeerde gewonnen levensjaren (QALYs, oftewel gewonnen gezonde levensjaren) en alleen kosten binnen het gezondheidszorgperspectief zijn meegenomen.
    Andere kosten- en effectencategorieen zoals ziekteverzuim hebben ook een grote invloed op de kosteneffectiviteit van de interventies. Onderzoek naar de bredere kosten en effecten van preventieve interventies is daarom gewenst.

    Increasing alcohol taxes and case finding of sub-threshold depression and subsequent treatment thereof are both preventive interventions that yield high benefits at low costs. Case finding of sub-threshold depression in the setting of the Dutch general practitioner is estimated to result in health gains of approximately 13,000 QALYs at a cost of euro 6.800,- per QALY gained. The planned Dutch alcohol tax increase for 2009 results in on average 13,000 QALYs at a cost of euro 5.100,- per QALY gained.
    This report describes research on the cost-effectiveness of increases in alcohol taxes and case finding of sub-threshold depression and subsequent treatment thereof with Minimal Contact Psychotherapy (MCP). Both interventions have been proven effective in previous research. However, not much is known on the cost-effectiveness of these interventions. Therefore, using simulation models, the cost effectiveness of these interventions has been investigated for the Netherlands in this report. To do this, a health care perspective was taken implying that only health care costs were taken into account and that effects were expressed in Quality Adjusted Life Years (QALYs).
    Especially for the tax increase, taking the health care perspective effectively illustrated the advantages compared to interventions whose intervention costs traditionally fall inside the health sector like treatment of alcohol addiction or curative treatments in a hospital setting. For depression, which also has a high impact on health care costs, our modelling exercise revealed that even within this narrow perspective ignoring several important costs outside the health care setting, prevention of major depression appears to be cost-effective. However, it deserves recommendation to carry out further research into these interventions focusing on costs and consequences outside the health care sector.
    Publisher
    Rijksinstituut voor Volksgezondheid en Milieu RIVM
    Sponsors
    VWS-PG
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