title: Depression, health-related quality of life, and medical cost outcomes of receiving recommended levels of antidepressant treatment.
abstract: BACKGROUND
  We evaluated depression severity, health-related quality of life (HRQL), and medical cost outcomes of primary care patients receiving recommended and less-than-recommended levels of antidepressant treatment.
  
  
  METHODS
  We performed a secondary analysis of clinical trial data from primary care clinics in a staff-model managed care organization. The trial included patients with Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for major depression who were starting antidepressant treatment. The primary outcomes measures used were the 17-item Hamilton Depression Rating Scale (HDRS), Hopkins Symptom Checklist depression scores, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) mental and physical component summary scores, and the total outpatient and inpatient medical costs.
  
  
  RESULTS
  Of 358 patients starting antidepressant treatment, 195 (54.5%) received doses recommended by the Agency for Health Care Policy and Research for 90 days or more. Mean HDRS score decreased from 14.1 to 8.8 in patients receiving less-than-recommended treatment and decreased from 13.8 to 8.9 in patients with minimum recommended treatment (P = .761). No significant differences in improvement of HRQL outcomes during 6 months were observed between patients receiving recommended or less-than-recommended antidepressant therapy. Mean total medical costs over 6 months for patients taking the recommended levels of antidepressant treatment were $1872 +/- 140 compared with $2622 +/- 413 for patients taking less-than-recommended treatment (P = .032). The differences in total medical costs were attributable to significantly lower nonmental health-related inpatient costs in the recommended antidepressant treatment group ($104 vs $785, P = .004).
  
  
  CONCLUSIONS
  Patients receiving minimum recommended levels of antidepressant therapy for 3 months showed improvement in depression severity and HRQL comparable with patients receiving less-than-recommended treatment. Patients receiving minimum recommended treatment had lower total costs and nonmental health-related inpatient costs. Antidepressant treatment in primary care patients may have the greatest impact on the frequency of health care visits and on costs for medical conditions and impairments.
authors.affiliation: Center for Health Outcomes Research, MEDTAP International, Bethesda, MD 20814-4805, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Revicki
authors.forename: G E
authors.initials: GE
authors.lastname: Simon
authors.forename: K
authors.initials: K
authors.lastname: Chan
authors.forename: W
authors.initials: W
authors.lastname: Katon
authors.forename: J
authors.initials: J
authors.lastname: Heiligenstein
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D014861:Washington
chemical_list: D000928:Antidepressive Agents