title: Gender patterns in cost effectiveness of quality improvement for depression: results of a randomized, controlled trial.
abstract: BACKGROUND
  Little is known about gender differences in the costs and outcomes of primary care quality improvement strategies for depression.
  
  
  METHODS
  Intent-to-treat analysis of data from a group-level controlled trial, in which matched primary care clinics in the US were randomized to usual care or to one of two interventions designed to increase the rate of effective depression treatment. One intervention facilitated medication management ("QI-Meds") and the other psychotherapy ("QI-Therapy"), but patients and clinicians could choose the type of treatment, or none. The study involved 46 clinics in 6 non-academic, managed care organizations; 181 primary care providers; and 375 male and 981 female patients with current depression. Outcomes are health care costs, quality-adjusted life years (QALY), depression burden, employment, and costs/QALY, over 24 months of follow-up.
  
  
  RESULTS
  Relative to usual care, QI-Therapy significantly reduced depression burden and increased employment, for men and women; but QI-Meds significantly reduced depression burden only among women. Average health care costs increased 429 USD in QI-Meds and 983 USD in QI-Therapy among men; corresponding cost increases were 424 and 275 USD for women. The estimated cost per QALY for men ranged between 16,600 and 42,600 USD under QI-Therapy. For women, estimated costs per QALY were 23,600 USD or below for QI-Meds and 12,500 USD or below under QI-Therapy.
  
  
  CONCLUSIONS
  This study may be underpowered for some relevant outcomes, particularly costs. The study population is limited to patients who sought health care in primary care settings.
  
  
  CONCLUSIONS
  Both men and women can benefit substantially from quality improvement interventions for depression in primary care. Results are particularly favorable for the QI-Therapy intervention.
authors: RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050, USA. mikels@rand.org
authors: Michael
authors: M
authors: Schoenbaum
authors: Cathy
authors: C
authors: Sherbourne
authors: Kenneth
authors: K
authors: Wells
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome