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1 of 2 quality improvement interventions for depression in managed care was more effective but more costly than usual care

Design
Cost effectiveness analysis from a societal perspective for a cluster randomised {allocation concealed^*}, unblinded,^* controlled trial with 2 years of follow up.

Setting
46 primary care clinics in 6 community based managed care organisations (MCOs) in the USA.

Patients
1356 patients who were 18 years of age {mean age 44 y, 71% women}, planned to use the primary care clinic over the next 12 months, and met the Composite International Diagnostic Interview criteria for depression. Follow up at 2 years was 85%.

Intervention
Matched clinics were allocated to 1 of 2 QI interventions or to usual care (ie, mailing of practice guidelines) (16 clinics, 443 patients). The QI interventions consisted of training for practice leaders and nurses, enhanced educational and assessment resources, and either nurses for medication follow up (QI-meds, 12 clinics, 424 patients) or access to trained psychotherapists (QI-treatment, 15 clinics, 489 patients).

Main cost and outcome measures
Outcomes were quality adjusted life years . . . [Full text of this article]

Margretta Diemer, MD, MPH, Christos Hatzigeorgiou, DO

Walter Reed Army Medical Center, Washington, DC, USA