title: Treatment and prevention of depression after surgery for hip fracture in older people: cost-effectiveness analysis.
abstract: OBJECTIVE
  For older people who have had hip fracture surgery, to evaluate the cost-effectiveness of a nurse-led intervention in treating depression compared to treatment as usual (TAU), and to evaluate the cost-effectiveness of a psychological treatment for the prevention of depression.
  
  
  METHODS
  Two linked cost-effectiveness studies for the treatment and prevention of depression after hip surgery, from the perspective of health, social care, voluntary sector agencies and unpaid carers.
  
  
  METHODS
  Orthopaedic units in Manchester, England.
  
  
  METHODS
  One hundred and twenty-one patients with Geriatric Depression Scale (GDS) scores greater than 6 were included in the treatment study and 172 patients with GDS scores less than or equal to 6 were enrolled in the prevention study.
  
  
  METHODS
  Nurse-led intervention for treating depression versus TAU; and cognitive behaviour therapy (CBT) for preventing depression following surgery for hip fracture.
  
  
  METHODS
  Outcomes were changes in HADS-depression scores at 6 weeks. Costs covered treatment and all service impacts.
  
  
  RESULTS
  After 6 weeks, there were no significant differences in cost. However, the nurse-led intervention group had a lower mean HADS-depression score compared to TAU. In the prevention study, there were no significant differences in cost and depression score between patients treated with CBT and TAU.
  
  
  CONCLUSIONS
  The results for this parallel randomized controlled study show that after hip fracture surgery a nurse-led intervention may be a cost-effective option for the treatment of depression in older people with depression. However CBT does not appear to be a cost-effective option for the prevention of depression in this population.
authors.affiliation: King's College London, Institute of Psychiatry, United Kingdom. renee.romeo@kcl.ac.uk
authors.forename: Renee
authors.initials: R
authors.lastname: Romeo
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
authors.forename: Sube
authors.initials: S
authors.lastname: Banerjee
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.forename: Robert
authors.initials: R
authors.lastname: Baldwin
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tarrier
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.forename: Mike
authors.initials: M
authors.lastname: Horan
authors.forename: Alistair
authors.initials: A
authors.lastname: Burns
mesh_terms: D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006620:Hip Fractures / Q000191:economics / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control / Q000523:psychology; D011568:Psychiatric Nursing / Q000191:economics