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Table 3 Cost-effectiveness of primary care interventions based on collaborative care.

From: Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review

First author Population Accepted as CC because: Cost measurement Effectiveness measurement Results
Von Korff et al, 1998[23]
Prices based on the year: unknown
Primary care patients (US), newly diagnosed major depression (DSM-III-R), N = 153
Mean age: I = 43.1, C = 44.8
Collaborative management, psychologist and physician, problem-solving treatment Health care perspective
Intervention costs, primary care costs
Follow-up: 7 months
SCL-90 score, successfully treated case of depression Incremental cost-effectiveness: $3741 per successfully treated case of major depression.
Reduction in SCL-score (70.4% vs. 42.3%)
Conclusion: strong indication for cost-effectiveness
Simon et al, 2001a[24]
Prices based on the year: 1996
Patients not responding to 8 weeks usual care, US primary care, major depression according to DSM-IV, N = 228
Mean age: I = 45.6, C = 45.4
Stepped care, patient education, advice to patient and physician by psychiatrist, ongoing management Social perspective
Intervention costs, non-depression primary care costs, total out-patient treatment costs, total health service costs
Follow-up: 6 months
SCL-90 score, HRQoL Incremental intervention related direct medical costs: $21 per DFD (95% CI $8 to $126) over 6 months.
Total healthcare costs $35 per DFD (95% CI -$52 to $388) over 6 months.
Patient costs: travelling expenses I = $1636 (95% CI 1356-1916) C = 1337 (95% CI 1174-1499)
I = 50% reduction SCL score, 95% CI 1.02 - 2.03.
Conclusion: strong indication for cost-effectiveness
Simon et al, 2001b[25]
Prices based on the year: unknown
High utilisers of medical care, high probability of undiagnosed major depression (DSM-IV), US primary care, N = 407.
Mean age: I = 47.2, C = 46.7
Depression management coordinated by primary care mental health worker, psychiatrist support, physician and patient education, using guidelines Health care perspective
Intervention costs, in- and outpatient depression treatment costs
Follow-up: 12 months
HRSD improvement, HRQoL, Intervention related direct medical costs $21 (95% CI $11 to $38) per DFD.
HRSD: 53.2% (I) vs. 32.8% (C) shows 50% improvement after 12 months
Conclusion: strong indication for cost-effectiveness
Schoenbaum et al, 2001[26]
Prices based on the year: 1998
US primary care, major depression according to DSM-IV, N = 1356
Mean age: I = 44.5, C = 42.2
Nurse specialists follow-up patients, conjunction between nurse - primary care physician and specialist Health care perspective
Depression primary care costs, intervention costs, costs per QALY
Follow-up: 24 months
HRQoL (QALYs calculated from SF-12 and Depression burden days), CES-D Intervention related direct medical costs by SF-12 method $21 478 per QALY (confidence interval not given). By DFD method, 95% CI $9478 to $18 953
CES-D reduction: 50% for intervention.
Conclusion: strong indication for cost-effectiveness
Liu et al, 2003[27]
Prices based on the year: 2000
Veteran population, Male = 95%, Major depression according to DSM-IV, N = 354
Mean age: I = 57.8, C = 56.6
Patient education, progress evaluation, team meetings, stepped care Health care perspective
Total (outpatient) costs
Follow-up: 9 months
SCL-90 score DFD increment for I = 14.6 Intervention related direct medical costs: I = $615 higher, $3754 (CI 3329-4179) vs. $3139 (CI 2759 -3519).
Total intervention costs: I = $1259 higher; $7946 (CI 5582-10310) vs. $6789 (CI 4720-8858).
I = SCL sign. better at 3 months (P < .25)
Conclusion: strong indication for cost-effectiveness
Araya et al, 2006[28]
Prices based on the year: 2004
Females 18-70 years, major depression according to DSM-IV, N = 240
Mean age: I = 44.1 (SD 12.1) and C = 42.0 (SD 13.7)
Monitoring clinical progress, manager coordinates with physicians, stepped care Health care perspective
Costs per patient, cost-effectiveness ratio
Follow-up: 6 months
HRSD score DFD: I = 50 more. Incremental cost-effectiveness ratio = 0.75. Intervention related direct medical costs: I = $87.8 per patient (CI 78.9 - 103.4), C = $51.5 per patient (CI 43.0 - 60.5)
Conclusion: cost-effective
Katon et al, 2005[29]
Prices based on the year: unknown
Diabetes, major depression according to DSM-IV, N = 1801
Mean age: I = 71, C = 71.4
Based on IMPACT protocol, stepped care, depression care manager consults with professionals, problem-solving treatment Health care perspective
Outpatient mental health costs, costs per QALY
Follow-up: 24 months
HSCL-20 improvement, QALYs Increment in DFD 1st year: 52.6 (CI 42.2 - 63.0). Increment in DFD 2nd year: 54.3 (CI 42.2 - 66.2). Intervention related direct medical costs 2nd year follow-up = $921 higher than CAU. Costs per QALY: $2519 (95% CI -$4517 to $9554)) to $5037 (95% CI -$9034 to $19 108).
Conclusion: strong indication for cost-effectiveness
Simon et al, 2007[30]
Prices based on the year: unknown
Diabetes and major depression according to DSM-IV, N = 329
Mean age: I = 58, C = 57
Stepped care, depression nurse coordinates contacts with professionals and patient, treatment based on the IMPACT-model Health care perspective
Outpatient costs
Follow-up: 24 months
SCL-90 score Increment in DFD: I = 20 in 1st year, 33 in 2nd year. Intervention related direct medical costs costs: I = $1400 lower in 2nd year, mean I = $600 lower in 2nd year.
Health services in 2 years: I = $21148 (SD 27548) vs. C = $22258 (SD 35607)
Conclusion: strong indication for cost-effectiveness
  1. C = control, CC = collaborative care; CE = cost-effectiveness; CES-D = Centre for Epidemiologic Studies-Depression scale; DFD = depression free days; DSM = diagnostic and statistical Manual of mental disorders; E = effectiveness; HRQoL = health related quality of life; HRSD = Hamilton Rating Scale for Depression; HSCL-20 = Hopkins symptom checklist -20; I = intervention; MADRS = Montgomery Åsberg depression rating scale; PRIME-MD = primary care evaluation of mental disorders; QALY = quality adjusted life year; SCL-90 = Symptom checklist - 90; SF-12 = Short Form