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Simon, Gregory E., Willard G. Manning, David J. Katzelnick, Steven D. Pearson, Henry J. Henk, Cindy P. Helstad: Cost-effectiveness of Systematic Depression Treatment for High Utilizers of General Medical Care. Archives of General Psychiatry. 58:181-187, 2001.

Background Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care.

Methods Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates about the 85^th percentile for 2 consecutive years. A 2-step screening process identified patients with currents depressive disorders, who were not in active treatment. Eligible patients were randomly assigned to continued usual care (n = 189) or to an organized depression management program (n = 218). The program included patient education, antidepressant pharmacotherapy initiated in primary care (when appropriate), systematic telephone monitoring of adherence and outcomes, and psychiatric consultation as needed. Clinical outcomes (assessed using the Hamilton Depression Rating Scale on 4 occasions throughout 12 months) were converted to measures of "depression-free days." Health services utilization and costs were estimated using health plan-standard claims.

Results The intervention program led to an adjusted increase of 47.7 depression-free days throughout 12 months (95% confidence interval [CI], 28.2–67.8 days). Estimated cost increases were $1008 per year (95% CI, $848–$3171), and $2475 for health services plus time-in-treatment costs (95% CI, $880–$4138). Including total health service and time-in-treatment costs, estimated incremental cost per depression-free day was $51.84 (95% CI, $17.37–$108.47)

Conclusion Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health service costs.