Earlier versions of this work were presented at the International Health Economics Association Meeting, York, U.K., July 2001 and the Fifth Workshop on Costs and Assessment in Psychiatry sponsored by the World Psychiatric Association Section on Mental Health Economics, Chicago, Ill, May 2000.
Cost-effectiveness of a Primary Care Depression Intervention
Article first published online: 30 JUN 2003
Journal of General Internal Medicine
Volume 18, Issue 6, pages 432–441, June 2003
How to Cite
Pyne, J. M., Rost, K. M., Zhang, M., Williams, D. K., Smith, J. and Fortney, J. (2003), Cost-effectiveness of a Primary Care Depression Intervention. Journal of General Internal Medicine, 18: 432–441. doi: 10.1046/j.1525-1497.2003.20611.x
- Issue published online: 30 JUN 2003
- Article first published online: 30 JUN 2003
- cost-benefit analysis;
- quality of life;
- primary health care
OBJECTIVE: To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care.
DESIGN: Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months.
SETTING: Primary care practices located in 10 states across the United States.
PATIENTS/PARTICIPANTS: Two hundred eleven patients beginning a new treatment episode for major depression.
INTERVENTIONS: Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year.
MEASUREMENTS AND MAIN RESULTS: Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was $15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from $11,341 (using geographic block variables to control for pre-intervention service utilization) to $19,976 (increasing the cost estimates by 50%) per QALY.
CONCLUSIONS: This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation.