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1 University of Colorado Health Sciences Center, Aurora, Colo
2 HSR&D Center for Mental Healthcare and Outcomes Research and the Central Arkansas Veterans Healthcare System, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Ark
3 Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Ill.
CORRESPONDING AUTHOR: Kathryn Rost, PhD, University of Colorado, Health Sciences Center, Department of Family Medicine, UCHSC at Fitzsimons, PO Box 6508, Mail Stop F496, Aurora, CO 80045-0508, Kathryn.Rost{at}UCHSC.edu
PURPOSE Although potentially costly, enhancing primary care depression management on an ongoing basis results in substantial long-term treatment effectiveness. The purpose of this article is to compare the cost-effectiveness of this approach with that of usual care.
METHODS The study was conducted in 12 community primary care practices randomized to enhanced or usual care after stratification by baseline practice patterns. Practices assigned to enhanced care encouraged depressed patients to engage in active treatment, using practice nurses to provide regularly scheduled care management during the course of 24 months. We analyze outcomes for 211 adults (73.4% of potential eligible patients) beginning a new treatment episode for major depression determined by previsit screening. Outcomes included blinded estimates of days free of depression impairment as well as health care costs for 2 years.
RESULTS Enhanced care significantly increased the number of days free of depression impairment for 2 years when compared with usual care (647.6 days vs 588.2 days, P <.01). The incremental cost-effectiveness ratio for enhanced care ranged from $9,592 to $14,306 per quality-adjusted life-year (QALY). The number of incremental days free of depression impairment increased between the first year and the second year (23.0 vs 36.4, respectively, P <.001) while incremental health plan costs decreased significantly ($568 vs -$12, P <.001).
CONCLUSIONS Enhancing primary care depression management on an ongoing basis should be considered for adoption by policy and health plan leaders.
Key Words: Cost-effectiveness • cost-benefit analysis • depression • quality of life • primary care • mental health
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