TY - JOUR
KW - Adult
KW - Antidepressive Agents/economics/therapeutic use
KW - Attitude to Health
KW - Cost-Benefit Analysis
KW - Counseling/economics
KW - Depressive Disorder, Major/drug therapy/economics/therapy
KW - Diagnostic and Statistical Manual of Mental Disorders
KW - Female
KW - Humans
KW - Male
KW - Primary Health Care/economics/methods
AU - J. M. Pyne
AU - K. M. Rost
AU - F. Farahati
AU - S. P. Tripathi
AU - J. Smith
AU - D. K. Williams
AU - J. Fortney
AU - J. C. Coyne
A1 - 
AB - BACKGROUND: Despite their impact on outcomes, the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied. This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention. METHOD: Twelve community primary-care practices were stratified and then randomized to enhanced (intervention) or usual care. Subjects included 211 patients beginning a new treatment episode for major depression. At baseline, 111 (52.6%) and 145 (68.7%) reported receptivity to antidepressant medication and counseling respectively. The intervention trained the primary-care teams to assess, educate, and monitor depressed patients. Twelve-month incremental (enhanced minus usual care) total costs and quality-adjusted life years (QALYs) were calculated. RESULTS: Among patients receptive to antidepressants, the mean incremental cost-effectiveness ratio was dollar 5,864 per QALY (sensitivity analyses up to dollar 14,689 per QALY). For patients not receptive to antidepressants, the mean incremental QALY score was negative (for both main and sensitivity analyses), or the intervention was at least no more effective than usual care. CONCLUSIONS: These findings suggest a re-thinking of the 'one size fits all' depression intervention, given that half of depressed primary-care patients may be non-receptive to antidepressant medication treatment. A brief assessment of treatment receptivity should occur early in the treatment process to identify patients most likely to benefit from primary-care quality improvement efforts for depression treatment. Patient treatment preferences are also important for the development, design, and analysis of depression interventions.
BT - Psychological medicine
C5 - Financing & Sustainability
CP - 6
CY - England
IS - 6
JF - Psychological medicine
N2 - BACKGROUND: Despite their impact on outcomes, the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied. This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention. METHOD: Twelve community primary-care practices were stratified and then randomized to enhanced (intervention) or usual care. Subjects included 211 patients beginning a new treatment episode for major depression. At baseline, 111 (52.6%) and 145 (68.7%) reported receptivity to antidepressant medication and counseling respectively. The intervention trained the primary-care teams to assess, educate, and monitor depressed patients. Twelve-month incremental (enhanced minus usual care) total costs and quality-adjusted life years (QALYs) were calculated. RESULTS: Among patients receptive to antidepressants, the mean incremental cost-effectiveness ratio was dollar 5,864 per QALY (sensitivity analyses up to dollar 14,689 per QALY). For patients not receptive to antidepressants, the mean incremental QALY score was negative (for both main and sensitivity analyses), or the intervention was at least no more effective than usual care. CONCLUSIONS: These findings suggest a re-thinking of the 'one size fits all' depression intervention, given that half of depressed primary-care patients may be non-receptive to antidepressant medication treatment. A brief assessment of treatment receptivity should occur early in the treatment process to identify patients most likely to benefit from primary-care quality improvement efforts for depression treatment. Patient treatment preferences are also important for the development, design, and analysis of depression interventions.
PP - England
PY - 2005
SN - 0033-2917; 0033-2917
SP - 839
EP - 854
EP - 
T1 - One size fits some: The impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention
T2 - Psychological medicine
TI - One size fits some: The impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention
U1 - Financing & Sustainability
U2 - 15997604
VL - 35
VO - 0033-2917; 0033-2917
Y1 - 2005
ER -