title: Cost-effectiveness of a program to prevent depression relapse in primary care.
abstract: OBJECTIVE
  Evaluate the incremental cost-effectiveness of a depression relapse prevention program in primary care.
  
  
  METHODS
  Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks later. Those recovered from the current episode but at high risk for relapse (based on history of recurrent depression or dysthymia) were offered randomization to usual care or a relapse prevention intervention. The intervention included systematic patient education, two psychoeducational visits with a depression prevention specialist, shared decision-making regarding maintenance pharmacotherapy, and telephone and mail monitoring of medication adherence and depressive symptoms. Outcomes in both groups were assessed via blinded telephone assessments at 3, 6, 9, and 12 months and health plan claims and accounting data.
  
  
  RESULTS
  Intervention patients experienced 13.9 additional depression-free days during a 12-month period (95% CI, -1.5 to 29.3). Incremental costs of the intervention were $273 (95% CI, $102 to $418) for depression treatment costs only and $160 (95% CI, -$173 to $512) for total outpatient costs. Incremental cost-effectiveness ratio was $24 per depression-free day (95% CI, -$59 to $496) for depression treatment costs only and $14 per depression-free day (95% CI, -$35 to $248) for total outpatient costs.
  
  
  CONCLUSIONS
  A program to prevent depression relapse in primary care yields modest increases in days free of depression and modest increases in treatment costs. These modest differences reflect high rates of treatment in usual care. Along with other recent studies, these findings suggest that improved care of depression in primary care is a prudent investment of health care resources.
authors.affiliation: Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA. simon.g@ghc.org
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Simon
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Terry
authors.initials: T
authors.lastname: Bush
authors.forename: Edward
authors.initials: E
authors.lastname: Walker
mesh_terms: D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics* / Q000517:prevention & control*; D017050:Episode of Care; D006801:Humans; D007407:Interviews as Topic; D011314:Preventive Health Services / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D015397:Program Evaluation; D012008:Recurrence; D016896:Treatment Outcome; D014861:Washington
chemical_list: D000928:Antidepressive Agents