Costs and consequences of enhanced primary care for depression

Abstract

BackgroundA 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.MethodWe conducted a systematic review of all full economicevaluations (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.ResultsWe 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.ConclusionsImproved 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.