01/10/2006 Medicine Political Science
DOI: 10.1192/bjp.bp.105.016006 SemanticScholar ID: 19914477 MAG: 2173932423

Costs and consequences of enhanced primary care for depression

Publication Summary

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 UKpounds/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 ($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.

CAER Authors

Avatar Image for Simon Gilbody

Prof. Simon Gilbody

University of York - Director of the Mental Health and Addictions Research Group

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