TY - JOUR
KW - Ambulatory Care/economics
KW - Antidepressive Agents/economics/therapeutic use
KW - Cost-Benefit Analysis
KW - Delivery of Health Care/economics
KW - Depressive Disorder/economics/psychology/therapy
KW - Female
KW - Health Care Costs
KW - Health Maintenance Organizations/economics
KW - Health Services/utilization
KW - Humans
KW - Insurance Claim Review/statistics & numerical data
KW - Male
KW - Middle Aged
KW - Patient Compliance
KW - Patient Education as Topic
KW - Primary Health Care/economics/utilization
KW - Treatment Outcome
AU - G. E. Simon
AU - W. G. Manning
AU - D. J. Katzelnick
AU - S. D. Pearson
AU - H. J. Henk
AU - C. S. Helstad
A1 - 
AB - BACKGROUND: Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care. METHODS: Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates above the 85th percentile for 2 consecutive years. A 2-step screening process identified patients with current depressive disorders, who were not in active treatment. Eligible patients were randomly assigned to continued usual care (n = 189) or to an organized depression management program (n = 218). The program included patient education, antidepressant pharmacotherapy initiated in primary care (when appropriate), systematic telephone monitoring of adherence and outcomes, and psychiatric consultation as needed. Clinical outcomes (assessed using the Hamilton Depression Rating Scale on 4 occasions throughout 12 months) were converted to measures of "depression-free days." Health services utilization and costs were estimated using health plan-standardized claims. RESULTS: The intervention program led to an adjusted increase of 47.7 depression-free days throughout 12 months (95% confidence interval [CI], 28.2-67.8 days). Estimated cost increases were $1008 per year (95% CI, $534-$1383) for outpatient health services, $1974 per year for total health services costs (95% CI, $848-$3171), and $2475 for health services plus time-in-treatment costs (95% CI, $880-$4138). Including total health services and time-in-treatment costs, estimated incremental cost per depression-free day was $51.84 (95% CI, $17.37-$108.47). CONCLUSIONS: Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health services costs.
BT - Archives of General Psychiatry
C5 - Financing & Sustainability
CP - 2
CY - United States
IS - 2
JF - Archives of General Psychiatry
N2 - BACKGROUND: Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care. METHODS: Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates above the 85th percentile for 2 consecutive years. A 2-step screening process identified patients with current depressive disorders, who were not in active treatment. Eligible patients were randomly assigned to continued usual care (n = 189) or to an organized depression management program (n = 218). The program included patient education, antidepressant pharmacotherapy initiated in primary care (when appropriate), systematic telephone monitoring of adherence and outcomes, and psychiatric consultation as needed. Clinical outcomes (assessed using the Hamilton Depression Rating Scale on 4 occasions throughout 12 months) were converted to measures of "depression-free days." Health services utilization and costs were estimated using health plan-standardized claims. RESULTS: The intervention program led to an adjusted increase of 47.7 depression-free days throughout 12 months (95% confidence interval [CI], 28.2-67.8 days). Estimated cost increases were $1008 per year (95% CI, $534-$1383) for outpatient health services, $1974 per year for total health services costs (95% CI, $848-$3171), and $2475 for health services plus time-in-treatment costs (95% CI, $880-$4138). Including total health services and time-in-treatment costs, estimated incremental cost per depression-free day was $51.84 (95% CI, $17.37-$108.47). CONCLUSIONS: Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health services costs.
PP - United States
PY - 2001
SN - 0003-990X; 0003-990X
SP - 181
EP - 187
EP - 
T1 - Cost-effectiveness of systematic depression treatment for high utilizers of general medical care
T2 - Archives of General Psychiatry
TI - Cost-effectiveness of systematic depression treatment for high utilizers of general medical care
U1 - Financing & Sustainability
U2 - 11177120
VL - 58
VO - 0003-990X; 0003-990X
Y1 - 2001
ER -