OBJECTIVE: The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile. METHOD: A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. RESULTS: Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars). CONCLUSIONS: The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.
RCT Entities:
OBJECTIVE: The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressedwomen in primary care in Santiago, Chile. METHOD: A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. RESULTS: Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars). CONCLUSIONS: The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressedwomen in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.
Authors: Jair de Jesus Mari; Luís Fernando Tófoli; Cristiano Noto; Li M Li; Alessandra Diehl; Angélica M Claudino; Mario F Juruena Journal: Drugs Date: 2013-09 Impact factor: 9.546
Authors: Charles F Reynolds; Pim Cuijpers; Vikram Patel; Alex Cohen; Amit Dias; Neerja Chowdhary; Olivia I Okereke; Mary Amanda Dew; Stewart J Anderson; Sati Mazumdar; Frank Lotrich; Steven M Albert Journal: Annu Rev Public Health Date: 2012-04 Impact factor: 21.981
Authors: Daisy R Singla; Brandon A Kohrt; Laura K Murray; Arpita Anand; Bruce F Chorpita; Vikram Patel Journal: Annu Rev Clin Psychol Date: 2017-05-08 Impact factor: 18.561
Authors: Christine Buttorff; Rebecca S Hock; Helen A Weiss; Smita Naik; Ricardo Araya; Betty R Kirkwood; Daniel Chisholm; Vikram Patel Journal: Bull World Health Organ Date: 2012-09-14 Impact factor: 9.408
Authors: Kirsten M van Steenbergen-Weijenburg; Christina M van der Feltz-Cornelis; Eva K Horn; Harm W J van Marwijk; Aartjan T F Beekman; Frans F H Rutten; Leona Hakkaart-van Roijen Journal: BMC Health Serv Res Date: 2010-01-19 Impact factor: 2.655