Design of a health-economic Markov model to assess cost-effectiveness and budget impact of the prevention and treatment of depressive disorder

Background/objective: To describe the design of ‘DepMod,’ a health-economic Markov model for assessing cost-effectiveness and budget impact of user-defined preventive interventions and treatments in depressive disorders. Methods: DepMod has an epidemiological layer describing how a cohort of people can transition between health states (sub-threshold depression, first episode of mild, moderate or severe depression (partial) remission, recurrence, death). Superimposed on the epidemiological layer, DepMod has an intervention layer consisting of a reference scenario and alternative scenario comparing the effectiveness and cost-effectiveness of a user-defined package of preventive interventions and psychological and pharmacological treatments of depression. Results are presented in terms of quality-adjusted life years (QALYs) gained and healthcare expenditure. Costs and effects can be modeled over 5 years and are subjected to probabilistic sensitivity analysis. Results: DepMod was used to assess the cost-effectiveness of scaling up preventive interventions for treating people with subclinical depression, which showed that there is an 82% probability that scaling up prevention is cost-effective given a willingness-to-pay threshold of €20,000 per QALY. Conclusion: DepMod is a Markov model that assesses the cost-utility and budget impact of different healthcare packages aimed at preventing and treating depression and is freely available for academic purposes upon request at the authors.