Cost-effectiveness of a disease management program for major depression in elderly primary care patients.

Full Abstract

BACKGROUND:
Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care.

OBJECTIVE:
To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care.

DESIGN:
Economic evaluation alongside a cluster randomized-controlled trial.

PARTICIPANTS:
Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis.

INTERVENTIONS:
General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way.

MEASUREMENTS:
Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs.

RESULTS:
Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval:
-1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups.

CONCLUSIONS:
This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.

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Author information

Author/s: Bosmans, Judith (J); de Bruijne, Martine (M); van Hout, Hein (H); van Marwijk, Harm (H); Beekman, Aartjan (A); Bouter, Lex (L); Stalman, Wim (W); van Tulder, Maurits (M);

Affiliation: Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands. judith.bosmans(-atsign-)falw.vu.nl

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine (J Gen Intern Med), published in United States. (Language: eng)

Reference: 2006-Oct; vol 21 (issue 10) : pp 1020-6

Dates: Created 2006/09/14; Completed 2006/10/18; Revised 2008/11/20;

PMID: 16836625, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Gen Intern Med. 2006 Oct;21(10):1125-7. (PMID: 16970563)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Cost-Benefit Analysis - economics
Depressive Disorder, Major - economics; therapy
Disease Management
Female

Humans
Male
Middle Aged
Primary Health Care - economics; methods
Treatment Outcome

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