Cost-effectiveness of systematic depression treatment for high utilizers of general medical care.
BACKGROUND
Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care.


METHODS
Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates above the 85th percentile for 2 consecutive years. A 2-step screening process identified patients with current depressive disorders, who were not in active treatment. Eligible patients were randomly assigned to continued usual care (n = 189) or to an organized depression management program (n = 218). The program included patient education, antidepressant pharmacotherapy initiated in primary care (when appropriate), systematic telephone monitoring of adherence and outcomes, and psychiatric consultation as needed. Clinical outcomes (assessed using the Hamilton Depression Rating Scale on 4 occasions throughout 12 months) were converted to measures of "depression-free days." Health services utilization and costs were estimated using health plan-standardized claims.


RESULTS
The intervention program led to an adjusted increase of 47.7 depression-free days throughout 12 months (95% confidence interval [CI], 28.2-67.8 days). Estimated cost increases were $1008 per year (95% CI, $534-$1383) for outpatient health services, $1974 per year for total health services costs (95% CI, $848-$3171), and $2475 for health services plus time-in-treatment costs (95% CI, $880-$4138). Including total health services and time-in-treatment costs, estimated incremental cost per depression-free day was $51.84 (95% CI, $17.37-$108.47).


CONCLUSIONS
Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health services costs.
Simon
G E
GE
Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA. simon.g@ghc.org
Manning
W G
WG
Katzelnick
D J
DJ
Pearson
S D
SD
Henk
H J
HJ
Helstad
C S
CS
D000553:Ambulatory Care / Q000191:economics; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D003866:Depressive Disorder / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome
D000928:Antidepressive Agents