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Costs and consequences of enhanced primary care for depression - Systematic review of randomised economic evaluations

Research output: Contribution to journalLiterature review

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JournalBritish Journal of Psychiatry
DatePublished - Oct 2006
Volume189
Number of pages12
Pages (from-to)297-308
Original languageEnglish

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 costeffective 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 pound ($13, no confidence interval given) to 13 pound ($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.

Declaration of interest None.

    Research areas

  • CONTROLLED-TRIAL, COLLABORATIVE CARE, QUALITY IMPROVEMENT, MAJOR DEPRESSION, HIGH UTILIZERS, MEDICAL-CARE, MANAGEMENT, INTERVENTION, PROGRAM, IMPACT

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