Costs and consequences of enhanced primary care for depression

Systematic review of randomised economic evaluations

GILBODY, SIMON DPhil, MRCPsych
BOWER, PETER PhD
WHITTY, PAULA MD, FFPH

Department of Health Sciences, University of York (GILBODY)
National Primary Care Research & Development Centre, University of Manchester (BOWER)
Centre for Health Services Research, University of Newcastle upon Tyne, UK (WHITTY)

Correspondence: Dr Simon Gilbody, Department of Health Sciences, University of York, York YO10 6DD, UK. Tel: +44 (0)1904 321370; fax: +44 (0)1904 321388; email: [email protected]

(First received 4 August 2005, final revision 2 December 2005, accepted 19 December 2005)

Declaration of interest None.

British Journal of Psychiatry 189(4):p 297-308, October 2006.

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.