Cost-effectiveness of integrated prevention for late-life depressive symptoms: Real-world findings from a large-scale pragmatic trial (“JoyAge”)

Background Integrated prevention, including stepped-care and task-sharing, is a theoretically resource-efficient approach to address late-life depression. Real-world evidence from large-scale community-based prevention programmes is lacking. We conducted a cost-effectiveness study embedded in a pragmatic non-randomised controlled trial to evaluate JoyAge, an integrated prevention programme for late-life depression, which has been shown to reduce loneliness, anxiety and depressive symptoms compared with routine care. Methods We compared an intention-to-treat sample of people receiving JoyAge ( n = 2975) with people receiving usual care ( n = 441) for incremental depression-free days (DFDs), quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness at 1 year. Using a two-part model to estimate incremental costs, nonparametric bootstrap was used to simulate 5000 incremental cost-effectiveness ratios. Cost-effectiveness probability was evaluated against US, UK, and WHO willingness-to-pay thresholds for QALY gain. Subgroup analyses were performed by baseline depressive symptom/prevention levels. Results At an incremental cost of US$251, JoyAge has an incremental effectiveness of 31.86 DFDs and 0.01 QALYs. Incremental cost-effectiveness ratios were US$9 per DFD (95% CI: −9, 27) and US$20,063 per QALY (95% CI: −23,527, 82,287). JoyAge has a 95% likelihood of being cost-effective at willingness-to-pay thresholds of US$24 per DFD, and is 99.9% likely to be cost-effective per QALY using the WHO threshold. Selective prevention dominated in gaining DFDs and QALYs. Indicated prevention and treatment were more effective but more expensive than care-as-usual. Conclusions JoyAge presented good value for money compared with care-as-usual. Decision-makers should consider integrated preventive programmes for late-life depression in rapidly ageing and lower-resource societies. Copyright © 2026. Published by Elsevier B.V.