Abstract
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.
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Dr. Pyne is supported by a VA Research Career Development Award and the Veterans Integrated Services Network 16 Mental Illness Research, Education, and Clinical Center (MIRECC). Dr. Rost is supported by grants MH54444 and MH63651, and Dr. Fortney is supported by grant AA12085 from MIRECC.
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Pyne, J.M., Rost, L.M., Zhang, M. et al. Cost-effectiveness of a primary care depression intervention. J GEN INTERN MED 18, 432–441 (2003). https://doi.org/10.1046/j.1525-1497.2003.20611.x
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DOI: https://doi.org/10.1046/j.1525-1497.2003.20611.x