Article Figures & Data
Figures
- Figure 1.
Patient recruitment and participation flowchart.
* A total of 110 patients received any program contact, including 2 patients who participated after 6 months only.
- Figure 2.
Enhanced care effect on outcomes (n=211).
Tables
Activity Time Cost per Hour $ Mean per Capita Cost $ Note: Screening by office assistant, care manager, and physician cost per hour derived from Bureau of Labor Statistics estimate for median office assistant, registered nurse, and general/family practitioner earnings plus 25% fringe benefits inflated to year 2000 dollars. Office assistant, care manager, and physician time estimates derived from care management report. * Identifying 115 patients beginning a new treatment episode required screening 5,838 patients. Office assistant screening .050 hr per screening test 3 5,838 screening tests /115* 13.91 35.28 Care manager preparation .115 hr per contact 3 11.8 contacts 24.40 33.11 Care manager contacts .210 hr per contact 3 11.8 contacts 24.40 60.46 Care manager record keeping .165 hr per contact 3 11.8 contacts 24.40 47.51 Physician review of care manager’s records .550 hr 85.51 47.03 Care manager communication with physician .216 hr 24.40 5.27 Physician communication with care manager .216 hr 85.51 18.47 Overhead 30% of above costs 74.14 2-year total costs 321.27 Annual costs 160.64 Costs Year 1 Mean $ (95% CI) Year 2 Mean $ (95% CI) Total Mean $ (95% CI) Note: Medication-adjusted costs refer to estimates of outpatient costs when fluoxetine, sertraline, and paroxetine become available for generic price of $.50 per dose. CI = confidence interval. Program 158 (147 to 169) 130 (120 to 140) 288 (267 to 309) Outpatient Nonadjusted 410 (395 to 425) −142 (−162 to −122) 268 (233 to 303) Medication adjusted 225 (211 to 238) −188 (−203 to −173) 37 (8 to 65) Patient time and transportation 107 (103 to 111) 38 (34 to 42) 145 (137 to 153) Total Nonadjusted 675 (645 to 705) 26 (−8 to 60) 701 (637 to 765) Medication adjusted 490 (461 to 518) −20 (−49 to 9) 470( 412 to 527) - Table 3.
Cost-Effectiveness of Primary Care Programs for Depressed Patients Beginning a New Treatment Episode Compared with Usual Care
Study Unique Characteristics of Sample Depression-Specific QALY Measure Cost Measure Annual Costs* $ Outcome†d/y Duration of Analysis Months * Costs based on year 2000 dollars. † Depression-free or impairment-free days per year attributable to program. ‡ Hargreaves WA, Hunkeler EM, Meresman J, Fireman B, Kirsch A. Cost-effectiveness of nurse telecare in primary care treatment of depression. 2003, personal communication. QALY = quality-adjusted life -years Katon et al2 Beginning antidepressant treatment SCL derivation of depression-free days Outpatient costs Program costs not included 467 15.8 6 Katon et al4 Beginning antidepressant treatment SCL derivation of depression-free days Outpatient costs Program costs not included 575 13.4 6 Lave et al33 Medication (M) Hamilton and Beck derivation of depression-free days Program and training costs; inpatient and outpatient costs; patient time and transportation 1,701 (M) 58.0 12 Therapy (T) 1,994 (T) 49.0 Simon et al10 Beginning antidepressant treatment SCL derivation of depression-free days Outpatient costs Program costs not included 149 12.6 6 Simon et al34 High utilizers Hamilton derivation of depression-free days Program costs; outpatient costs Program costs; inpatient and outpatient costs Program costs; inpatient and outpatient costs; patient time 1,008 1,974 2,475 47.4 12 Hargreaves et al‡ Beginning antidepressant treatment Hamilton derivation of depression-free days Program costs; inpatient and outpatient costs 307 12.3 6 Current study Direct report of depression impairment-free days Program costs; outpatient costs; patient time and transportation 350 29.7 24
Supplemental Appendix
Covariates to control from sociodemographic and clinical differences between patients in practices randomized to enhanced and usual care.
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 1 page, 61KB
The Article in Brief
This study provides the first evidence that when depressed patients are cared for in the primary care doctor�s office for an extended period, they have better results, and the treatment becomes less costly. In this study, depressed patients were encouraged to take part in active treatment and received regularly scheduled care for 2 years. These patients had more depression-free days than patients who received regular care. The care was found to be cost-effective and, according to the authors, is an efficient use of health care resources. The authors encourage health plans to provide for long- rather than short-term depression management.
