One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention.
BACKGROUND
Despite their impact on outcomes, the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied. This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.


METHODS
Twelve community primary-care practices were stratified and then randomized to enhanced (intervention) or usual care. Subjects included 211 patients beginning a new treatment episode for major depression. At baseline, 111 (52.6%) and 145 (68.7%) reported receptivity to antidepressant medication and counseling respectively. The intervention trained the primary-care teams to assess, educate, and monitor depressed patients. Twelve-month incremental (enhanced minus usual care) total costs and quality-adjusted life years (QALYs) were calculated.


RESULTS
Among patients receptive to antidepressants, the mean incremental cost-effectiveness ratio was dollar 5,864 per QALY (sensitivity analyses up to dollar 14,689 per QALY). For patients not receptive to antidepressants, the mean incremental QALY score was negative (for both main and sensitivity analyses), or the intervention was at least no more effective than usual care.


CONCLUSIONS
These findings suggest a re-thinking of the 'one size fits all' depression intervention, given that half of depressed primary-care patients may be non-receptive to antidepressant medication treatment. A brief assessment of treatment receptivity should occur early in the treatment process to identify patients most likely to benefit from primary-care quality improvement efforts for depression treatment. Patient treatment preferences are also important for the development, design, and analysis of depression interventions.
VA HSRD Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR 72114-1706, USA. jmpyne@uams.edu
Jeffrey M
JM
Pyne
Kathryn M
KM
Rost
Farah
F
Farahati
Shanti P
SP
Tripathi
Jeffrey
J
Smith
D Keith
DK
Williams
John
J
Fortney
James C
JC
Coyne
D000328:Adult; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics* / Q000379:methods*
D000928:Antidepressive Agents