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Costs and consequences of enhanced primary care for depression: Systematic review of randomised economic evaluations

Lookup NU author(s): Dr Paula Whitty


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Background: A number of enhancement strategies have been proposed to improve the quality and outcome of care for depression in primary care settings. Decision-makers are likely to need to know whether these interventions are cost-effective in routine primary care settings. Method: We conducted a systematic review of all full economicevaluations (cost-effectiveness and cost-utility analyses) accompanying randomised controlled trials of enhanced primary care for depression. Costs were standardised to UK pounds/US dollars and incremental cost-effectiveness ratios (ICERs) were visually summarised using a permutation matrix. Results: We identified 11 full economic evaluations (4757 patients). A near-uniform finding was that the interventions based upon collaborative care/case management resulted in improved outcomes but were also associated with greater costs. When considering primary care depression treatment costs alone, ICER estimates ranged from £7 ($13, no confidence interval given) to £13 ($24, 95% CI-105 to 148) per additional depression-free day. Educational interventions alone were associated with increased cost and no clinical benefit. Conclusions: Improved outcomes through depression management programmes using a collaborative care/case management approach can be expected, but are associated with increased cost and will require investment. Declaration of interest: None.

Publication metadata

Author(s): Gilbody S, Bower P, Whitty P

Publication type: Review

Publication status: Published

Journal: British Journal of Psychiatry

Year: 2006

Volume: 189

Issue: 4

Pages: 297-308

ISSN (print): 0007-1250

ISSN (electronic): 1472-1465


DOI: 10.1192/bjp.bp.105.016006