BACKGROUND: A number of enhancement strategies have been proposed to improve the quality and outcome of care for depression in primary care settings. Decision-makers are likely to need to know whether these interventions are cost-effective in routine primary care settings. METHOD: We conducted a systematic review of all full economic evaluations (cost-effectiveness and cost-utility analyses) accompanying randomised controlled trials of enhanced primary care for depression. Costs were standardised to UK pounds/US dollars and incremental cost-effectiveness ratios (ICERs) were visually summarised using a permutation matrix. RESULTS: We identified 11 full economic evaluations (4757 patients). A near-uniform finding was that the interventions based upon collaborative care/case management resulted in improved outcomes but were also associated with greater costs. When considering primary care depression treatment costs alone, ICER estimates ranged from 7 ($13, no confidence interval given) to 13 UK pounds ($24,95% CI -105 to 148) per additional depression-free day. Educational interventions alone were associated with increased cost and no clinical benefit. CONCLUSIONS: Improved outcomes through depression management programmes using a collaborative care/case management approach can be expected, but are associated with increased cost and will require investment.
BACKGROUND: A number of enhancement strategies have been proposed to improve the quality and outcome of care for depression in primary care settings. Decision-makers are likely to need to know whether these interventions are cost-effective in routine primary care settings. METHOD: We conducted a systematic review of all full economic evaluations (cost-effectiveness and cost-utility analyses) accompanying randomised controlled trials of enhanced primary care for depression. Costs were standardised to UK pounds/US dollars and incremental cost-effectiveness ratios (ICERs) were visually summarised using a permutation matrix. RESULTS: We identified 11 full economic evaluations (4757 patients). A near-uniform finding was that the interventions based upon collaborative care/case management resulted in improved outcomes but were also associated with greater costs. When considering primary care depression treatment costs alone, ICER estimates ranged from 7 ($13, no confidence interval given) to 13 UK pounds ($24,95% CI -105 to 148) per additional depression-free day. Educational interventions alone were associated with increased cost and no clinical benefit. CONCLUSIONS: Improved outcomes through depression management programmes using a collaborative care/case management approach can be expected, but are associated with increased cost and will require investment.
Authors: Osvaldo P Almeida; Jane Pirkis; Ngaire Kerse; Moira Sim; Leon Flicker; John Snowdon; Brian Draper; Gerard Byrne; Robert Goldney; Nicola T Lautenschlager; Nigel Stocks; Helman Alfonso; Jon J Pfaff Journal: Ann Fam Med Date: 2012 Jul-Aug Impact factor: 5.166
Authors: Kathleen M Grubbs; Ann M Cheney; John C Fortney; Carrie Edlund; Xiaotong Han; Patricia Dubbert; Cathy D Sherbourne; Michelle G Craske; Murray B Stein; Peter P Roy-Byrne; J Greer Sullivan Journal: Psychiatr Serv Date: 2014-12-15 Impact factor: 3.084
Authors: Robert O Morgan; David M Bass; Katherine S Judge; C F Liu; Nancy Wilson; A Lynn Snow; Paul Pirraglia; Maurilio Garcia-Maldonado; Paul Raia; N N Fouladi; Mark E Kunik Journal: J Gen Intern Med Date: 2015-02-10 Impact factor: 5.128
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
Authors: Jeffrey C Eisen; Monika Marko-Holguin; Joshua Fogel; Alonso Cardenas; My Bahn; Nathan Bradford; Blake Fagan; Peggy Wiedmann; Benjamin W Van Voorhees Journal: Prim Care Companion CNS Disord Date: 2013-12-19