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Does Primary Care Treatment of Depression Save Money?

Researchers have found that depressed patients use more general medical services than the general population and that treating depression reduces visits to doctors for unexplained physical complaints. These investigators randomly assigned 407 high utilizers of health services (more than 7 visits per year) at 3 HMOs who met DSM-IV criteria for major depression either currently or within the past 2 years with current partial remission, to usual medical care with the opportunity for depression treatment or to usual care plus a comprehensive depression-management program. The comprehensive program included assessments, psychoeducation, regular follow-ups by primary care physicians and research assistants, and, usually, treatment with therapeutic doses of sertraline or nortriptyline. Number of depression-free days, measured with a standardized rating scale, and cost of care were evaluated regularly for 12 months.

Depression-management patients were about 3 times as likely as treatment-as-usual patients to receive and to continue antidepressant treatment and averaged 47 more depression-free days. Depression-management patients averaged $1974 more in health service costs per year than usual-care patients, mostly because of antidepressants ($412), monitoring by study coordinators, occasional psychiatric hospitalizations, and additional checkups by physicians. As a result, each additional depression-free day in the depression-management group cost $41.34.

Comment: Treatment of depression by primary care practitioners was effective in this study, but overall reductions in healthcare utilization did not offset the additional cost of adequate depression treatment. If this finding is reliable, society will have to decide whether the benefits of not being depressed, which probably include improved work productivity and quality of life, are worth a cost that seems rather modest, when compared with the price of other common medical interventions.

— S Dubovsky

Published in Journal Watch Psychiatry March 6, 2001

Citation(s):

Simon GE et al. Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Arch Gen Psychiatry 2001 Feb 58 181-187.

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