Evaluation of a rehabilitation group intervention in patients with persistent depressive disorder and their partner.

OBJECTIVES/RESEARCH QUESTION: What are costs and effects of group-oriented Psychiatrie Rehabilitation ("Patient and Partner Education Program for All chronic diseases": PPEP4AII) in patients with Persistent Depressive Disorder (PDD) and their partner (or significant other), compared to Usual care?


HYPOTHESIS: Compared to Usual care, PPEP4AII will cost less, lead to better quality of life, fewer psychological symptoms, more resilience, less chronic disease burden.
STUDY DESIGN: Multicentre Pragmatic Randomised Controlled Trial (superiority design).


STUDY POPULATION: Patiënts with PDD (chronic depressed >2 yr), > 18 yr, with their partner/significant other.


INTERVENTION: PPEP4AII (www.ppep4all.nl) with 9 weekly group sessions Rehabilitation and separate partner group.
USUAL CARE: Pharmaco- and/or psychotherapy and psychiatrie nurse guidance.


OUTCOME MEASURES: Primary is quality of life (QALYs); Secondary are costs, psychopathology, resilience, disease burden.


SAMPLE SIZE CALCULATION & DATA ANALYSIS: Based upon power (.85) and alpha (.05), 514 patients are needed (including 10% attrition): 2x257 (PPEP4AII vs Usual care). Primary data analysis: T-test for quality of life using EQ-5D-5L results and cost-effectiveness analysis (at 1 yr). Secondary data analysis: all secondary parameters (weighted generalized estimating equation analyses) and Budget Impact Analysis. All analyses according to intention-to-treat principle; and subgroup analyses for age, gender, ethnicity.


COST-EFFECTIVENESS ANALYSIS (CEA) & BUDGET IMPACT ANALYSIS (BIA): Economic evaluation (CEA) will consist of cost-utility analysis from societal perspective with time horizon of 1 yr. Health care use, patient cost/expenditure, and absence from work will be assessed. Differences in mean costs and effects between strategies will be compared with two-sided bootstrapping. In a net-benefit analysis, costs will be related to patient reported outcomes. In the BIA, the consequences of different scenarios with regard to the extent of implementation of PPEP4AII will be assessed from several perspectives (societal, public purse, health insurer, health care provider).


TIME SCHEDULE: total of 48 mths. Start-up 3 mnths (1-3); lnclusion/assessments/data entry 30 mnths (4-33); Analysis/publications 15 mnths (34-48).

Compared to usual care, PPEP4All will cost less, lead to better quality of life, fewer psychological symptoms, more resilience, and less chronic disease burden for both patient and partner.

T1 baseline; T2 post-treatment at 3 months; T3 follow-up 1 at 6 months; T4 follow-up 2 at 12 months.

PPEP4All (Patient and Partner Education program for All chronic diseases) compared with usual care.