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A depression management programme increased depression free days and costs in depressed frequent users of general healthcare

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QUESTION: In depressed patients who are frequent healthcare users, what is the incremental cost effectiveness of a depression management programme (DMP)?

Design

Cost effectiveness analysis of a cluster randomised (unclear allocation concealment*), partially blinded (telephone assessment)*, controlled trial with 12 months of follow up.

Setting

3 health maintenance organisations (HMOs) in the US (Wisconsin, Massachusetts, and Washington).

Patients

407 patients (mean age 45 y, 77% women) who were frequent users of general medical care (>85th percentile for the number of visits in each of the previous 2 years) and were depressed (Hamilton Depression Rating Scale [HDRS] score ≥15). Exclusion criteria were active treatment for depression in previous 90 days or contraindications to depression treatment. Analysis included 92% of patients for healthcare use and 91% for cost effectiveness.

Intervention

{82} physician practices were allocated to a DMP (n=218) and {81} were allocated to usual care (n=189). DMP consisted of education and telephone care management, antidepressant treatment for most patients, and psychiatric consultation for non-responders.

Main cost and outcome measures

The main outcome was number of depression free days (estimated by interpolation). Direct costs were assessed for all services provided or paid for by health plans in 1996 US dollars. Costs for time in treatment were estimated as lost wages. …

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