TY - JOUR
KW - Cost of Illness
KW - Cost-Benefit Analysis
KW - Depressive Disorder/economics/therapy
KW - Employment
KW - Family Practice/economics/standards
KW - Health Care Costs/statistics & numerical data
KW - Health Services Research/methods
KW - Humans
KW - Managed Care Programs/economics/standards
KW - Mental Health Services/economics/standards
KW - Outcome and Process Assessment (Health Care)
KW - Primary Health Care/economics/standards
KW - Quality Assurance, Health Care/economics
KW - Quality-Adjusted Life Years
KW - United States
AU - M. Schoenbaum
AU - J. Unutzer
AU - C. Sherbourne
AU - N. Duan
AU - L. V. Rubenstein
AU - J. Miranda
AU - L. S. Meredith
AU - M. F. Carney
AU - K. Wells
A1 - 
AB - CONTEXT: Depression is a leading cause of disability worldwide, but treatment rates in primary care are low. OBJECTIVE: To determine the cost-effectiveness from a societal perspective of 2 quality improvement (QI) interventions to improve treatment of depression in primary care and their effects on patient employment. DESIGN: Group-level randomized controlled trial conducted June 1996 to July 1999. SETTING: Forty-six primary care clinics in 6 community-based managed care organizations. PARTICIPANTS: One hundred eighty-one primary care clinicians and 1356 patients with positive screening results for current depression. INTERVENTIONS: Matched practices were randomly assigned to provide usual care (n = 443 patients) or to 1 of 2 QI interventions offering training to practice leaders and nurses, enhanced educational and assessment resources, and either nurses for medication follow-up (QI-meds; n = 424 patients) or trained local psychotherapists (QI-therapy; n = 489). Practices could flexibly implement the interventions, which did not assign type of treatment. MAIN OUTCOME MEASURES: Total health care costs, costs per quality-adjusted life-year (QALY), days with depression burden, and employment over 24 months, compared between usual care and the 2 interventions. RESULTS: Relative to usual care, average health care costs increased $419 (11%) in QI-meds (P =.35) and $485 (13%) in QI-therapy (P =.28); estimated costs per QALY gained were between $15 331 and $36 467 for QI-meds and $9478 and $21 478 for QI-therapy; and patients had 25 (P =.19) and 47 (P =.01) fewer days with depression burden and were employed 17.9 (P =.07) and 20.9 (P =.03) more days during the study period. CONCLUSIONS: Societal cost-effectiveness of practice-initiated QI efforts for depression is comparable with that of accepted medical interventions. The intervention effects on employment may be of particular interest to employers and other stakeholders.
BT - JAMA : the journal of the American Medical Association
C5 - Education & Workforce; Financing & Sustainability
CP - 11
CY - United States
IS - 11
JF - JAMA : the journal of the American Medical Association
N2 - CONTEXT: Depression is a leading cause of disability worldwide, but treatment rates in primary care are low. OBJECTIVE: To determine the cost-effectiveness from a societal perspective of 2 quality improvement (QI) interventions to improve treatment of depression in primary care and their effects on patient employment. DESIGN: Group-level randomized controlled trial conducted June 1996 to July 1999. SETTING: Forty-six primary care clinics in 6 community-based managed care organizations. PARTICIPANTS: One hundred eighty-one primary care clinicians and 1356 patients with positive screening results for current depression. INTERVENTIONS: Matched practices were randomly assigned to provide usual care (n = 443 patients) or to 1 of 2 QI interventions offering training to practice leaders and nurses, enhanced educational and assessment resources, and either nurses for medication follow-up (QI-meds; n = 424 patients) or trained local psychotherapists (QI-therapy; n = 489). Practices could flexibly implement the interventions, which did not assign type of treatment. MAIN OUTCOME MEASURES: Total health care costs, costs per quality-adjusted life-year (QALY), days with depression burden, and employment over 24 months, compared between usual care and the 2 interventions. RESULTS: Relative to usual care, average health care costs increased $419 (11%) in QI-meds (P =.35) and $485 (13%) in QI-therapy (P =.28); estimated costs per QALY gained were between $15 331 and $36 467 for QI-meds and $9478 and $21 478 for QI-therapy; and patients had 25 (P =.19) and 47 (P =.01) fewer days with depression burden and were employed 17.9 (P =.07) and 20.9 (P =.03) more days during the study period. CONCLUSIONS: Societal cost-effectiveness of practice-initiated QI efforts for depression is comparable with that of accepted medical interventions. The intervention effects on employment may be of particular interest to employers and other stakeholders.
PP - United States
PY - 2001
SN - 0098-7484; 0098-7484
SP - 1325
EP - 1330
EP - 
T1 - Cost-effectiveness of practice-initiated quality improvement for depression: Results of a randomized controlled trial
T2 - JAMA : the journal of the American Medical Association
TI - Cost-effectiveness of practice-initiated quality improvement for depression: Results of a randomized controlled trial
U1 - Education & Workforce; Financing & Sustainability
U2 - 11560537
VL - 286
VO - 0098-7484; 0098-7484
Y1 - 2001
ER -