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JAMA. 2001 Sep 19;286(11):1325-30.

Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial.

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  • 1RAND, 1200 S Hayes St, Arlington, VA 22202, USA. mikels@rand.org

Abstract

CONTEXT:

Depression is a leading cause of disability worldwide, but treatment rates in primary care are low.

OBJECTIVE:

To determine the cost-effectiveness from a societal perspective of 2 quality improvement (QI) interventions to improve treatment of depression in primary care and their effects on patient employment.

DESIGN:

Group-level randomized controlled trial conducted June 1996 to July 1999.

SETTING:

Forty-six primary care clinics in 6 community-based managed care organizations.

PARTICIPANTS:

One hundred eighty-one primary care clinicians and 1356 patients with positive screening results for current depression.

INTERVENTIONS:

Matched practices were randomly assigned to provide usual care (n = 443 patients) or to 1 of 2 QI interventions offering training to practice leaders and nurses, enhanced educational and assessment resources, and either nurses for medication follow-up (QI-meds; n = 424 patients) or trained local psychotherapists (QI-therapy; n = 489). Practices could flexibly implement the interventions, which did not assign type of treatment.

MAIN OUTCOME MEASURES:

Total health care costs, costs per quality-adjusted life-year (QALY), days with depression burden, and employment over 24 months, compared between usual care and the 2 interventions.

RESULTS:

Relative to usual care, average health care costs increased $419 (11%) in QI-meds (P =.35) and $485 (13%) in QI-therapy (P =.28); estimated costs per QALY gained were between $15 331 and $36 467 for QI-meds and $9478 and $21 478 for QI-therapy; and patients had 25 (P =.19) and 47 (P =.01) fewer days with depression burden and were employed 17.9 (P =.07) and 20.9 (P =.03) more days during the study period.

CONCLUSIONS:

Societal cost-effectiveness of practice-initiated QI efforts for depression is comparable with that of accepted medical interventions. The intervention effects on employment may be of particular interest to employers and other stakeholders.

Comment in

PMID:
11560537
[PubMed - indexed for MEDLINE]
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