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Costs and consequences of enhanced primary care for depression: Systematic review of randomised economic evaluations

  • Simon Gilbody (a1), Peter Bower (a2) and Paula Whitty (a3)
Abstract
Background

A number of enhancement strategies have been proposed to improve the quality and outcome of care for depression in primary care settings. Decision-makers are likely to need to know whether these interventions are cost-effective in routine primary care settings.

Method

We conducted a systematic review of all full economicevaluations (cost-effectiveness and cost-utility analyses) accompanying randomised controlled trials of enhanced primary care for depression. Costs were standardised to UK pounds/US dollars and incremental cost-effectiveness ratios (ICERs) were visually summarised using a permutation matrix.

Results

We identified 11 full economic evaluations (4757 patients). A near-uniform finding was that the interventions based upon collaborative care/case management resulted in improved outcomes but were also associated with greater costs. When considering primary care depression treatment costs alone, ICER estimates ranged from £7 ($13, no confidence interval given) to £13 ($24, 95% CI—105 to 148) per additional depression-free day. Educational interventions alone were associated with increased cost and no clinical benefit.

Conclusions

Improved outcomes through depression management programmes using a collaborative care/case management approach can be expected, but are associated with increased cost and will require investment.

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Copyright
Corresponding author
Dr Simon Gilbody, Department of Health Sciences, University of York, York YO10 6DD, UK. Tel: +44(0)1904 321370; fax: +44(0)1904 321388; email: sg519@york.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Costs and consequences of enhanced primary care for depression: Systematic review of randomised economic evaluations

  • Simon Gilbody (a1), Peter Bower (a2) and Paula Whitty (a3)
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