Cost-effectiveness of Practice-Initiated Quality Improvement for Depression

摘要: ContextDepression is a leading cause of disability worldwide, but treatment rates in primary care are low.ObjectiveTo determine the cost-effectiveness from societal perspective 2 quality improvement (QI) interventions to improve treatment depression in and their effects on patient employment.DesignGroup-level randomized controlled trial conducted June 1996 July 1999.SettingForty-six clinics 6 community-based managed organizations.ParticipantsOne hundred eighty-one clinicians 1356 patients with positive screening results for current depression.InterventionsMatched practices were randomly assigned provide usual (n = 443 patients) or 1 2 QI offering training practice leaders nurses, enhanced educational assessment resources, either nurses medication follow-up (QI-meds; n = 424 trained local psychotherapists (QI-therapy; 489). Practices could flexibly implement the interventions, which did not assign type treatment.Main Outcome MeasuresTotal health costs, costs per quality-adjusted life-year (QALY), days with depression burden, employment over 24 months, compared between usual interventions.ResultsRelative care, average increased $419 (11%) in QI-meds (P .35) $485 (13%) QI-therapy (P .28); estimated QALY gained between $15 331 $36 467 $9478 $21 478 QI-therapy; and had 25 .19) 47 .01) fewer days burden employed 17.9 .07) 20.9 .03) more days during study period.ConclusionsSocietal practice-initiated efforts depression is comparable that accepted medical interventions. The intervention effects may be particular interest employers other stakeholders.