Cost-effectiveness of Systematic Depression Treatment for High Utilizers of General Medical Care

Gregory E. Simon · Willard G. Manning · David J. Katzelnick · Steven D. Pearson · Henry J. Henk · Cindy P. Helstad

198 citations0/0 files storedArchives of General Psychiatry

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Health Systems, Economic Evaluations, Quality of Life Mental Health Treatment and Access Treatment of Major Depression

Abstract

BACKGROUND: Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care. METHODS: Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates above the 85th percentile for 2 consecutive years. A 2-step screening process identified patients with current depressive disorders, who were not in active treatment. Eligible patients were randomly assigned to continued usual care (n = 189) or to an organized depression management program (n = 218). The program included patient education, antidepressant pharmacotherapy initiated in primary care (when appropriate), systematic telephone monitoring of adherence and outcomes, and psychiatric consultation as needed. Clinical outcomes (assessed using the Hamilton Depression Rating Scale on 4 occasions throughout 12 months) were converted to measures of "depression-free days." Health services utilization and costs were estimated using health plan-standardized claims. RESULTS: The intervention program led to an adjusted increase of 47.7 depression-free days throughout 12 months (95% confidence interval [CI], 28.2-67.8 days). Estimated cost increases were $1008 per year (95% CI, $534-$1383) for outpatient health services, $1974 per year for total health services costs (95% CI, $848-$3171), and $2475 for health services plus time-in-treatment costs (95% CI, $880-$4138). Including total health services and time-in-treatment costs, estimated incremental cost per depression-free day was $51.84 (95% CI, $17.37-$108.47). CONCLUSIONS: Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health services costs.

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1960A RATING SCALE FOR DEPRESSION 1996Cost-Effectiveness in Health and Medicine 1989The functioning and well-being of depressed patients. Results from the Medical Outcomes Study 1994Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study 1995Collaborative management to achieve treatment guidelines. Impact on depression in primary care 1995Five‐Hundred Life‐Saving Interventions and Their Cost‐Effectiveness 1998The logged dependent variable, heteroscedasticity, and the retransformation problem 1996A Multifaceted Intervention to Improve Treatment of Depression in Primary Care

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