Cost-utility analysis of routine anxiety and depression screening in patients consulting for osteoarthritis: results from a clinical, randomized controlled trial

Objective: To investigate the cost-effectiveness (cost-utility) of introducing general practitioner screening for anxiety and depression in patients consulting with osteoarthritis (OA). Methods: A cluster-randomised trial-based economic evaluation to assess general practitioners screening for anxiety and depression symptoms in patients consulting with OA compared to usual care (screening for pain intensity) was undertaken over a 12-month period from a UK National Health Service and Societal perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were estimated and cost-effectiveness acceptability curves controlling for cluster-level data were constructed. The base-case analysis used the net-benefit regressions approach. The two-stage non-parametric sampling technique was explored in a sensitivity analysis. Results: The base-case analysis demonstrated that the intervention was as costly as, and less effective than, the control (QALY diff, 95% CI: - 0.029 (95% CI -0.062 to 0.003)). In the base-case analyses, GP screening for anxiety and depression was unlikely to be a cost-effective option (probability < 5% at £20,000/QALY). Similar results were observed in all sensitivity analyses. Conclusions: Prompting GP’s to routinely screen and manage comorbid anxiety and depression in patients presenting with OA is unlikely to be cost-effective. Further research is needed to explore clinically-effective and cost-effective models of managing anxiety and depression in patients presenting with clinical OA. Key words economic evaluation, cost-effectiveness, cost-utility, osteoarthritis, depression, anxiety, screening, and case-finding Trial registration: ISRCTN registry ISRCTN40721988