Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations

Br J Psychiatry. 2006 Oct:189:297-308. doi: 10.1192/bjp.bp.105.016006.

Abstract

Background: A number of enhancement strategies have been proposed to improve the quality and outcome of care for depression in primary care settings. Decision-makers are likely to need to know whether these interventions are cost-effective in routine primary care settings.

Method: We conducted a systematic review of all full economic evaluations (cost-effectiveness and cost-utility analyses) accompanying randomised controlled trials of enhanced primary care for depression. Costs were standardised to UK pounds/US dollars and incremental cost-effectiveness ratios (ICERs) were visually summarised using a permutation matrix.

Results: We identified 11 full economic evaluations (4757 patients). A near-uniform finding was that the interventions based upon collaborative care/case management resulted in improved outcomes but were also associated with greater costs. When considering primary care depression treatment costs alone, ICER estimates ranged from 7 ($13, no confidence interval given) to 13 UK pounds ($24,95% CI -105 to 148) per additional depression-free day. Educational interventions alone were associated with increased cost and no clinical benefit.

Conclusions: Improved outcomes through depression management programmes using a collaborative care/case management approach can be expected, but are associated with increased cost and will require investment.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cost-Benefit Analysis
  • Depressive Disorder / economics*
  • Depressive Disorder / therapy
  • Health Care Costs
  • Humans
  • Primary Health Care / economics*
  • Program Evaluation
  • Randomized Controlled Trials as Topic