Cost-effectiveness of a primary care depression intervention

Area of Science:

• Health Services Research
• Mental Health Interventions
• Economic Evaluations

Background:

• Depression is a leading cause of disability worldwide.
• Effective management of depression in primary care is crucial for improving patient outcomes.
• Quality improvement initiatives can enhance the delivery of mental health services.

Purpose of the Study:

• To evaluate the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) compared to usual care in primary care settings.
• To determine the economic value of enhanced depression care in a real-world primary care environment.

Main Methods:

• A randomized controlled trial involving 12 primary care practices across the United States.
• 211 patients with major depression were randomized to either enhanced care or usual care.
• Intervention involved training primary care teams to manage depression over a 1-year period, measuring costs and quality-adjusted life years (QALYs) using SF-36 data.

Main Results:

• The mean incremental cost-effectiveness ratio (ICER) for the enhanced care intervention was $15,463 per QALY.
• Sensitivity analyses yielded ICERs ranging from $11,341 to $19,976 per QALY.
• The intervention demonstrated a favorable cost-effectiveness profile compared to common primary care interventions.

Conclusions:

• The quality improvement depression intervention (enhanced care) is a cost-effective strategy compared to usual care.
• Enhanced care represents a valuable addition to primary care services for managing depression.
• The findings support the implementation of similar quality improvement programs to improve depression outcomes and resource utilization.