TY - JOUR
KW - Aged
KW - Cost-Benefit Analysis/economics
KW - Depressive Disorder, Major/economics/therapy
KW - Disease Management
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Primary Health Care/economics/methods
KW - Treatment Outcome
AU - J. Bosmans
AU - M. de Bruijne
AU - H. van Hout
AU - H. van Marwijk
AU - A. Beekman
AU - L. Bouter
AU - W. Stalman
AU - M. van Tulder
A1 - 
AB - BACKGROUND: Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. OBJECTIVE: To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care. DESIGN: Economic evaluation alongside a cluster randomized-controlled trial. PARTICIPANTS: Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis. INTERVENTIONS: General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way. MEASUREMENTS: Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs. RESULTS: Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups. CONCLUSIONS: This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
BT - Journal of general internal medicine
C5 - Financing & Sustainability
CP - 10
CY - United States
DO - 10.1111/j.1525-1497.2006.00555.x
IS - 10
JF - Journal of general internal medicine
N2 - BACKGROUND: Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. OBJECTIVE: To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care. DESIGN: Economic evaluation alongside a cluster randomized-controlled trial. PARTICIPANTS: Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis. INTERVENTIONS: General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way. MEASUREMENTS: Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs. RESULTS: Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups. CONCLUSIONS: This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
PP - United States
PY - 2006
SN - 1525-1497; 0884-8734
SP - 1020
EP - 1026
EP - 
T1 - Cost-effectiveness of a disease management program for major depression in elderly primary care patients
T2 - Journal of general internal medicine
TI - Cost-effectiveness of a disease management program for major depression in elderly primary care patients
U1 - Financing & Sustainability
U2 - 16836625
U3 - 10.1111/j.1525-1497.2006.00555.x
VL - 21
VO - 1525-1497; 0884-8734
Y1 - 2006
ER -