Cost-effectiveness of a disease management program for major depression in elderly primary care patients.
BACKGROUND
Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care.


OBJECTIVE
To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care.


METHODS
Economic evaluation alongside a cluster randomized-controlled trial.


METHODS
Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis.


METHODS
General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way.


METHODS
Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs.


RESULTS
Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups.


CONCLUSIONS
This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
Bosmans
Judith
J
Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands. judith.bosmans@falw.vu.nl
de Bruijne
Martine
M
van Hout
Hein
H
van Marwijk
Harm
H
Beekman
Aartjan
A
Bouter
Lex
L
Stalman
Wim
W
van Tulder
Maurits
M
D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome