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QUESTION: In patients with depression, are either of 2 quality improvement (QI) interventions for improving the treatment of depression in managed care more cost effective 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 …