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A depression management programme increased depression free days and costs in depressed frequent users of general health care

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 QUESTION: In depressed patients who are frequent healthcare users, what is the incremental cost effectiveness of a depression management programme (DMP)?


Cost effectiveness analysis of a cluster randomised {allocation concealed*}, partially blinded (telephone assessment),* controlled trial with 12 months follow up.


3 health maintenance organisations (HMOs) in the US.


407 patients (mean age 45 y, 77% women) who were frequent users of general medical care (>85th centile for the number of outpatient visits in each of the previous 2 y) and were depressed (Hamilton Depression Rating Scale [HDRS] score ≥15). Exclusion criteria included active treatment for depression in the previous 90 days or contraindications to depression treatment. Analyses included 92% of patients for healthcare use and 91% for cost effectiveness.


{82} physician practices were allocated to a DMP (n=218), and {81} were allocated to usual care (n=189). DMP consisted of patient and physician education and telephone care management, antidepressant treatment for most patients, and psychiatric consultation for non-responders.

Main cost and outcome measures

The main outcome was number of depression free days (estimated by interpolation). Direct costs were assessed for all services provided or paid for by health plans in 1996 US dollars. Costs for time in treatment were estimated as lost wages. Results were adjusted for age, sex, study site, baseline measures of depression severity and health status, and clustering of patients …

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  • Source of funding: Pfizer Pharmaceuticals.

  • For correspondence: Dr G E Simon, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448, USA. Fax +1 206 287 2871.

  • Abstract and commentary also appear in Evidence-Based Mental Health.

  • * See glossary.

  • Information provided by author.

  • Katzelnick DJ, Simon GE, Pearson SD, et al. Arch Fam Med 2000;9:345–51.