Cost-utility analysis studies of depression management: a systematic review.
OBJECTIVE
Depression is common, costly, treatable, and a major influence on quality of life. Cost-utility analysis combines costs with quantity and quality of life into a metric that is meaningful for studies of interventions or care strategies and is directly comparable to measures in other such studies. The objectives of this study were to identify published cost-utility analyses of depression screening, pharmacologic treatment, nonpharmacologic therapy, and care management; to summarize the results of these studies in an accessible format; to examine the analytic methods employed; and to identify areas in the depression literature that merit cost-utility analysis.


METHODS
The authors selected articles regarding cost-utility analysis of depression management from the Harvard Center for Risk Analysis Cost-Effectiveness Registry. Characteristics of the publications, including study methods and analysis, were examined. Cost-utility ratios for interventions were arranged in a league table.


RESULTS
Of the 539 cost-utility analyses in the registry, nine (1.7%) were of depression management. Methods for determining utilities and the source of the data varied. Markov models or cohort simulations were the most common analytic techniques. Pharmacologic interventions generally had lower costs per quality-adjusted life year than nonpharmacologic interventions. Psychotherapy alone, care management alone, and psychotherapy plus care management all had lower costs per quality-adjusted life year than usual care. Depression screening and treatment appeared to fall within the cost-utility ranges accepted for common nonpsychiatric medical conditions.


CONCLUSIONS
There is a paucity of literature on cost-utility analysis of depression management. High-quality cost-utility analysis should be considered for further research in depression management.
Pirraglia
Paul A
PA
Rhode Island Hospital, 593 Eddy St., MPB-1, Providence, RI 02903, USA. ppirraglia@lifespan.org
Rosen
Allison B
AB
Hermann
Richard C
RC
Olchanski
Natalia V
NV
Neumann
Peter
P
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D016527:Drug Costs; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
D000928:Antidepressive Agents