Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 7, Issue 2, 2004. Pages: 69-76 Published Online: 30 May 2004 Copyright © 2004 ICMPE.

* Correspondence to: Michael Schoenbaum, Ph.D., RAND, 1200 South Hayes Street, Arlington, VA 22202, USA
Tel.: +1-703-413 1100 ext. 5426
Fax: +1-703-413 8111
E-mail: mikels@rand.org.

Source of Funding: This work was funded by the John D. and Catherine T. MacArthur Foundation, the Agency for Healthcare Research and Quality (R01-HS08349), and NIMH (5R01MH57992).

Abstract

Depression is a leading cause of disability, but treatment rates are low, particularly for minority patients. We estimate societal cost-effectiveness of two quality improvement interventions for depression, separately for Latino and White patients. Matched primary care clinics were randomized to usual care or to one of two quality improvement interventions for depression, one facilitating medication management ("QI-Meds") and the other psychotherapy ("QI-Therapy"). The study involved 398 Latino and 778 White patients with depression, in 46 clinics in 6 organizations. Relative to usual care, the estimated cost per quality-adjusted life year (QALY) for Latinos was $6,100 or less under QI-Therapy, well within the range of usual medical practice; but $90,000 or more in QI-Meds. For Whites, estimated costs per QALY were around $30,000 under both interventions, towards the upper end of usual medical practice. Both interventions increased labor supply for Latinos and Whites, by around one work month over two years.

Context: Depression is a leading cause of disability worldwide, but treatment rates are low, particularly for minority patients. Objective: To estimated societal cost-effectiveness of two interventions to improve care for depression in primary care, examining Latino and white patients separately. Methods: Intent-to-treat analysis of data from a group-level controlled trial, in which matched primary care clinics in the US were randomized to usual care or to one of two interventions designed to increase the rate of effective depression treatment. One intervention facilitated medication management (``QI-Meds'') and the other psychotherapy ("QI-Therapy''); but patients and clinicians could choose the type of treatment, or none. The study involved 46 clinics in 6 non-academic, managed care organizations; 181 primary care providers; and 398 Latino and 778 White patients with current depression. Outcomes are health care costs, quality-adjusted life years (QALY), depression burden, employment, and costs per QALY, over 24 months of follow-up. Results: Relative to usual care, QI-Therapy resulted in significantly fewer depression burden days for Latinos and increased days employed for white patients. Average health care costs increased $278 in QI-Meds and $161 in QI-Therapy for Latinos, and by $655 in QI-Meds and $752 in QI-Therapy for whites, relative to usual care. The estimated cost per QALY for Latinos was $6,100 or less under QI-Therapy, but $90,000 or more in QI-Meds. For Whites, estimated costs per QALY were around $30,000 under both interventions. Conclusions: Latinos benefit from improved care for depression, and the cost is less than that for white patients. Diverse patients are likely to benefit from improving care for depression in primary care.

Received 1 October 2003; accepted 10 March 2004

Copyright © 2004 ICMPE