Table 1 Model parameters and output under hypothetical usual care and four scenarios of improvement above baseline
Model Parameters | Baseline | Scenario 1: Increase detection | Scenario 2: Increase provider response | Scenario 3: Increase patient acceptance | Scenario 4: Increase treatment effectiveness |
|---|---|---|---|---|---|
Population | |||||
Arbitrary population of cancer patients | 10,000 | 10,000 | 10,000 | 10,000 | 10,000 |
Target group | |||||
Cancer patients with depression | 15% n = 55,500 | 15% n = 55,500 | 15% n = 55,500 | 15% n = 55,500 | 15% n = 55,500 |
Filter 1: detection | |||||
Detection (description) | Clinician judgement | Computerised short screening tool | Clinician judgement | Clinician judgement | Clinician judgement |
% and no. detected | 20% n = 300 | 35% n = 525 | 20% n = 300 | 20% n = 300 | 20% n = 300 |
Cost for detection (per person) | $5 | $10.00 | $5 | $5 | $5 |
Total cost for filter 1 | $7500 | $15,000 | $7500 | $7500 | $7500 |
Filter 2: Provider response | |||||
Provider response (description) | Clinician judgement | Clinician judgement | Provision of patient distress screening scores and recommendation to clinician | Clinician judgement | Clinician judgement |
% and no. offered treatment | 70% n = 210 | 70% n = 368 | 85% n = 255 | 70% n = 210 | 70% n = 210 |
Cost for provider (per person) | $5 | $5 | $10 | $5 | $5 |
Total cost for filter 2 | $1500 | $2625 | $3000 | $1500 | $1500 |
Filter 3: Patient acceptance | |||||
Patient acceptance (description) | Patient judgement | Patient judgement | Patient judgement | Distress scores & recommendation provided to patient | Patient judgement |
% and no. accept treatment | 30% n = 63 | 30% n = 110 | 30% n = 77 | 45% n = 95 | 30% n = 63 |
Cost for acceptance (per person) | $0 | $0 | $0 | $7.50 | $0 |
Total cost for filter 3 | $0 | $0 | $0 | $1575 | $0 |
Filter 4: Treatment efficacy | |||||
Treatment (description) | Referral to primary care | Referral to primary care | Referral to primary care | Referral to primary care | Collaborative care model |
Treatment outcome | No longer meets diagnostic criteria for depression | No longer meets diagnostic criteria for depression | No longer meets diagnostic criteria for depression | No longer meets diagnostic criteria for depression | No longer meets diagnostic criteria for depression |
% and no. treated successfully | 30% n = 19 | 30% n = 33 | 30% n = 23 | 30% n = 28 | 45% n = 28 |
Cost for treatment (per person) | $100 | $100 | $100 | $100 | $300 |
Total cost for filter 4 | $6300 | $11,025 | $7650 | $9450 | $18,900 |
Outcome metrics | |||||
Total cost | $15,300 | $28,650 | $18,110 | $20,025 | $27,900 |
Cost per patient receiving care | $242.86 | $260 | $237 | $212 | $443 |
Cost per successful outcome | $810 | $866 | $791 | $706 | $984 |
Incremental total cost compared to baseline | n/a | $13,350 | $2850 | $4725 | $12,600 |
Incremental number of patients successfully treated compared to baseline | n/a | 14 | 4 | 9 | 9 |
ICER | n/a | $942 | $704 | $500 | $1333 |
Policy Advice | n/a | Compared to usual care this scenario is MORE EXPENSIVE and has BETTER EFFECTIVENESS | Compared to usual care this scenario is MORE EXPENSIVE and has BETTER EFFECTIVENESS | Compared to usual care this scenario is MORE EXPENSIVE and has BETTER EFFECTIVENESS | Compared to usual care this scenario is MORE EXPENSIVE and has BETTER EFFECTIVENESS |