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Costs and consequences of enhanced primary care for depression

Systematic review of randomised economic evaluations

Department of Health Sciences, University of York

PETER BOWER, PhD

National Primary Care Research & Development Centre, University of Manchester

PAULA WHITTY, MD, FFPH

Centre for Health Services Research, University of Newcastle upon Tyne, UK

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: sg519{at}york.ac.uk

Declaration of interest None.

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.

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