Cost-Effectiveness of Quality Improvement Programs for Patients With Subthreshold Depression or Depressive Disorder

Kenneth B. Wells, Michael Schoenbaum, Naihua Duan, Jeanne Miranda, Lingqi Tang, Cathy D. Sherbourne

ResearchPublished Oct 1, 2007

OBJECTIVE: This study explored the cost-effectiveness of quality-improvement interventions for depression in primary care, relative to usual care, among patients with subthreshold depression or depressive disorder.

METHODS: A total of 746 primary care patients in managed care organizations with 12-month depressive disorder and 502 with current depressive symptoms but no disorder (subthreshold depression) participated in a group-level randomized controlled trial initiated between June 1996 and March 1997. Matched clinics were randomly assigned to enhanced usual care or one of two quality improvement interventions that provided education to manage depression over time and resources to facilitate access to medication management or psychotherapy for six to 12 months.

RESULTS: The cost-effectiveness ratio for the pooled intervention groups versus usual care was $2,028 for patients with subthreshold depression (95% confidence interval [CI]=-$17,225 to $21,282) and $53,716 for those with depressive disorder (CI=$14,194 to $93,238), by using a measure of quality-adjusted life years (QALY) based on the 12-Item Short Form Health Survey. Similar results were obtained when alternative QALY measures were used.

CONCLUSIONS: Although precision was limited, even the upper limit of the 95% CIs suggests that such interventions are as cost-effective for patients with subthreshold depression as are many widely used medical therapies. Despite lack of evidence for efficacy of treatments for subthreshold depression, disease management programs that support clinical care decisions over time for patients with subthreshold depression or depressive disorder can yield cost-effectiveness ratios comparable to those of widely adopted medical therapies. Achieving greater certainty about average cost-effectiveness would require a much larger study.

Reprinted with permission from Psychiatric Services, Vol. 58, No. 10, Oct. 2007, pp. 1269-1278. Copyright © 2007 American Psychiatric Association.

Topics

Document Details

  • Copyright: RAND Corporation
  • Publisher: American Psychiatric Association
  • Availability: Web-Only
  • Year: 2007
  • Pages: 10
  • Document Number: RP-1297

Originally published in: Psychiatric Services, Vol. 58, No. 10, Oct. 2007, pp. 1269-1278.

This publication is part of the RAND reprint series. The reprint series, a product of RAND from 1992 to 2011, included previously published journal articles, book chapters, and reports that were reproduced by RAND with the permission of the publisher. RAND reprints were formally reviewed in accordance with the publisher's editorial policy and compliant with RAND's rigorous quality assurance standards for quality and objectivity. For select current RAND journal articles, see external publications.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.