Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Recovery from depression, work productivity, and health care costs among primary care patients. Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Cost-effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Collaborative care models for the treatment of depression. Based on a presentation by Wayne Katon, MD. Treatment Costs, Cost Offset, and Cost-Effectiveness of Collaborative Management of Depression Cost-effectiveness of improving primary care treatment of late-life depression. Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis. RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients With Physical vs Psychological Complaints Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention. [Economic evaluation of a course in coping with depression]. A multifaceted intervention to improve treatment of depression in primary care. Depression, health-related quality of life, and medical cost outcomes of receiving recommended levels of antidepressant treatment. Cost-Effectiveness of a Program to Prevent Depression Relapse in Primary Care
CONTEXT Depression co-occurring with diabetes mellitus is associated with higher health services costs , suggesting that more effective depression treatment might reduce use of other medical services . OBJECTIVE To evaluate the incremental cost and cost-effectiveness of a systematic depression treatment program among out patients with diabetes . DESIGN R and omized controlled trial comparing systematic depression treatment program with care as usual . SETTING Primary care clinics of group-model prepaid health plan . PATIENTS A 2-stage screening process identified 329 adults with diabetes and current depressive disorder . INTERVENTION Specialized nurses delivered a 12-month , stepped-care depression treatment program beginning with either problem-solving treatment psychotherapy or a structured antidepressant pharmacotherapy program . Subsequent treatment ( combining psychotherapy and medication , adjustments to medication , and specialty referral ) was adjusted according to clinical response . MAIN OUTCOME MEASURES Depressive symptoms were assessed by blinded telephone assessment s at 3 , 6 , 12 , and 24 months . Health service costs were assessed using health plan accounting records . RESULTS Over 24 months , patients assigned to the intervention accumulated a mean of 61 additional days free of depression ( 95 % confidence interval [ CI ] , 11 to 82 days ) and had outpatient health services costs that averaged $ 314 less ( 95 % CI , $ 1007 less to $ 379 more ) compared with patients continuing in usual care . When an additional day free of depression is valued at $ 10 , the net economic benefit of the intervention is $ 952 per patient treated ( 95 % CI , $ 244 to $ 1660 ) . CONCLUSIONS For adults with diabetes , systematic depression treatment significantly increases time free of depression and appears to have significant economic benefits from the health plan perspective . Depression screening and systematic depression treatment should become routine components of diabetes care We describe a secondary analysis of data from a r and omized trial conducted at seven primary care clinics of a Seattle area HMO . Adults with major depression ( n=290 ) beginning antidepressant treatment completed structured interviews at baseline , 1 , 3 , 6 , 9 , 12 , 18 , and 24 months . Interviews examined clinical outcomes ( Hamilton Depression Rating Scale and depression module of the Structured Clinical Interview for DSM-IIIR ) , employment status , and work days missed due to illness . Medical comorbidity was assessed using computerized pharmacy data , and medical costs were assessed using the HMO 's computerized accounting data . Using data from the 12-month assessment , patients were classified as remitted ( 41 % ) , improved but not remitted ( 47 % ) , and persistently depressed ( 12 % ) . After adjustment for depression severity and medical comorbidity at baseline , patients with greater clinical improvement were more likely to maintain paid employment ( P=.007 ) and reported fewer days missed from work due to illness ( P<.001 ) . Patients with better 12-month clinical outcomes had marginally lower health care costs during the second year of follow-up ( P=.06 ) . We conclude that recovery from depression is associated with significant reductions in work disability and possible reductions in health care costs . Although observational data can not definitively prove any causal relationships , these longitudinal results strengthen previous findings regarding the economic burden of depression on employers and health insurers BACKGROUND Exp and ing 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 above the 85th percentile for 2 consecutive years . A 2-step screening process identified patients with current depressive disorders , who were not in active treatment . Eligible patients were r and omly 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-st and ardized cl aims . 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 , $ 534-$1383 ) for outpatient health services , $ 1974 per year for total health services costs ( 95 % CI , $ 848-$3171 ) , and $ 2475 for health services plus time-in-treatment costs ( 95 % CI , $ 880-$4138 ) . Including total health services and time-in-treatment costs , estimated incremental cost per depression-free day was $ 51.84 ( 95 % CI , $ 17.37-$108.47 ) . CONCLUSIONS 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 services costs OBJECTIVE To determine the incremental cost-effectiveness and net benefit of a depression collaborative care program compared with usual care for patients with diabetes and depression . RESEARCH DESIGN AND METHODS This article describes a preplanned subgroup analysis of patients with diabetes from the Improving Mood-Promoting Access to Collaborative ( IMPACT ) r and omized controlled trial . The setting for the study included 18 primary care clinics from eight health care organizations in five states . A total of 418 of 1,801 patients r and omized to the IMPACT intervention ( n = 204 ) versus usual care ( n = 214 ) had coexisting diabetes . A depression care manager offered education , behavioral activation , and a choice of problem-solving treatment or support of antidepressant management by the primary care physician . The main outcomes were incremental cost-effectiveness and net benefit of the program compared with usual care .  RESULTS Relative to usual care , intervention patients experienced 115 ( 95 % CI 72 - 159 ) more depression-free days over 24 months . Total outpatient costs were 25 dollars ( 95 % CI -1,638 to 1,689 ) higher during this same period . The incremental cost per depression-free day was 25 cents ( -14 dollars to 15 dollars ) and the incremental cost per quality -adjusted life year ranged from 198 dollars ( 144 - 316 ) to 397 dollars ( 287 - 641 ) . An incremental net benefit of 1,129 dollars ( 692 - 1,572 ) was found . CONCLUSIONS The IMPACT intervention is a high-value investment for older adults with diabetes ; it is associated with high clinical benefits at no greater cost than usual care OBJECTIVE To evaluate the cost-effectiveness of a socioculturally adapted collaborative depression care program among low-income Hispanics with diabetes . RESEARCH DESIGN AND METHODS A r and omized controlled trial of 387 patients with diabetes ( 96.5 % Hispanic ) with clinical ly significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program aim ed at increasing patient exposure to evidence -based depression psychotherapy and /or pharmacotherapy in two public safety net clinics . Patient medical care costs and utilization were captured from Los Angeles County Department of Health Services cl aims records . Patient-reported outcomes included Short-Form Health Survey-12 and Patient Health Question naire-9-calculated depression-free days . RESULTS Intervention patients had significantly greater Short-Form Health Survey-12 utility improvement from baseline compared with controls over the 18-month evaluation period ( 4.8 % ; P < 0.001 ) and a corresponding significant improvement in depression-free days ( 43.0 ; P < 0.001 ) . Medical cost differences were not statistically significant in ordinary least squares and log-transformed cost regressions . The average costs of the Multifaceted Diabetes and Depression Program study intervention were $ 515 per patient . The program 's cost-effectiveness averaged $ 4053 per quality -adjusted life-year per MDDP recipient and was more than 90 % likely to fall below $ 12,000 per quality -adjusted life-year . CONCLUSIONS Socioculturally adapted collaborative depression care improved utility and quality of life in predominantly low-income Hispanic patients with diabetes and was highly cost-effective OBJECTIVE The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management .  METHOD Primary care patients initiating antidepressant treatment completed a st and ardized telephone assessment 6 - 8 weeks after the initial prescription . Those with persistent major depression or significant subthreshold depressive symptoms were r and omly assigned to continued usual care or collaborative care . The collaborative care included systematic patient education , an initial visit with a consulting psychiatrist , 2 - 4 months of shared care by the psychiatrist and primary care physician , and monitoring of follow-up visits and adherence to medication regimen . Clinical outcomes were assessed through blinded telephone assessment s at 1 , 3 , and 6 months . Health services utilization and costs were assessed through health plan cl aims and accounting data . RESULTS Patients receiving collaborative care experienced a mean of 16.7 additional depression-free days over 6 months . The mean incremental cost of depression treatment in this program was $ 357 . The additional cost was attributable to greater expenditures for antidepressant prescriptions and outpatient visits . No off setting decrease in use of other health services was observed . The incremental cost-effectiveness was $ 21.44 per depression-free day . CONCLUSIONS A stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs . These findings are consistent with those of other r and omized trials . Improving outcomes of depression treatment in primary care requires investment of additional re sources , but the return on this investment is comparable to that of many other widely accepted medical interventions The quality of treatment of depression in the primary care setting is limited by inadequate patient education , lack of adherence to treatment regimens , poor patient follow-up , and the absence of close collaboration between medical and mental health systems . Integrated models of care may help overcome some of these barriers and improve adherence , satisfaction with care , and outcomes . The health and economic outcomes of r and omized controlled trials in which 2 models of collaborative care -- psychiatrist and psychiatrist/psychologist plus primary care -- were compared with usual primary care . Interventions were delivered at multiple levels and included enhanced patient education and monitoring , physician training , patient-physician interaction , and integration of a psychiatrist or psychologist into the primary care setting . After the interventions , patients with major depression showed significant improvements in adherence , satisfaction with care , and depressive outcomes , whereas , in patients with minor depression , outcomes were not significantly affected by the intervention . An analysis revealed that the cost of the interventions was higher than usual care , and that there was little evidence of any cost offset . However , in terms of cost effectiveness , the cost of successfully treating one patient with major depression was lower with the interventions , and the incremental costs of collaborative intervention were substantially lower than the usual primary care costs Objective This report estimates the treatment costs , cost-offset effects , and cost-effectiveness of Collaborative Care of depressive illness in primary care . Study Design Treatment costs , cost-offset effects , and cost-effectiveness were assessed in two r and omized , controlled trials . In the first r and omized trial ( N = 217 ) , consulting psychiatrists provided enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence . In the second r and omized trial ( N = 153 ) , Collaborative Care was implemented through brief cognitive-behavioral therapy and enhanced patient education . Consulting psychologists provided brief psychotherapy supplemented by educational material s and enhanced pharmacotherapy management . Results Collaborative Care increased the costs of treating depression largely because of the extra visits required to provide the interventions . There was a modest cost offset due to reduced use of specialty mental health services among Collaborative Care patients , but costs of ambulatory medical care services did not differ significantly between the intervention and control groups . Among patients with major depression there was a modest increase in cost-effectiveness . The cost per patient successfully treated was lower for Collaborative Care than for Usual Care patients . For patients with minor depression , Collaborative Care was more costly and not more cost-effective than Usual Care . Conclusions Collaborative Care increased depression treatment costs and improved the cost-effectiveness of treatment for patients with major depression . A cost offset in specialty mental health costs , but not medical care costs , was observed . Collaborative Care may provide a means of increasing the value of treatment services for major depression CONTEXT Depression is a leading cause of functional impairment in elderly individuals and is associated with high medical costs , but there are large gaps in quality of treatment in primary care . OBJECTIVE To determine the incremental cost-effectiveness of the Improving Mood Promoting Access to Collaborative Treatment ( IMPACT ) collaborative care management program for late-life depression . DESIGN R and omized controlled trial with recruitment from July 1999 to August 2001 . SETTING Eighteen primary care clinics from 8 health care organizations in 5 states . PARTICIPANTS A total of 1801 patients 60 years or older with major depression ( 17 % ) , dysthymic disorder ( 30 % ) , or both ( 53 % ) . INTERVENTION Patients were r and omly assigned to the IMPACT intervention ( n = 906 ) or to usual primary care ( n = 895 ) . Intervention patients were provided access to a depression care manager supervised by a psychiatrist and primary care physician . Depression care managers offered education , support of antidepressant medications prescribed in primary care , and problem-solving treatment in primary care ( a brief psychotherapy ) . MAIN OUTCOME MEASURES Total outpatient costs , depression-free days , and quality -adjusted life-years . RESULTS Relative to usual care , intervention patients experienced 107 ( 95 % confidence interval [ CI ] , 86 to 128 ) more depression-free days over 24 months . Total outpatient costs were USD $ 295 ( 95 % CI , -$525 to $ 1115 ) higher during this period . The incremental outpatient cost per depression-free day was USD $ 2.76 ( 95 % CI , -$4.95 to $ 10.47 ) and incremental outpatient costs per quality -adjusted life-year ranged from USD $ 2519 ( 95 % CI , -$4517 to $ 9554 ) to USD $ 5037 ( 95 % CI , -$9034 to $ 19 108 ) . Results of a bootstrap analysis suggested a 25 % probability that the IMPACT intervention was " dominant " ( ie , lower costs and greater effectiveness ) . CONCLUSIONS The IMPACT intervention is a high-value investment for older adults ; it is associated with high clinical benefits at a low increment in health care costs OBJECTIVE To compare the cost-effectiveness of generic psychological therapy ( counseling ) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months . METHODS Economic analysis alongside a r and omized clinical trial with patient preference arm . Comparison of depression-related health service costs at 12 months . Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves . RESULTS No significant difference between the mean observed costs of patients r and omized to antidepressants or to counseling ( 342 pounds sterling vs 302 pounds sterling , p = .56 [ t test ] ) . If decision makers are not willing to pay more for additional benefits ( value placed on extra patient with good outcome , denoted by K , is zero ) , then we find little difference between the treatment modalities in terms of cost-effectiveness . If decision makers do place value on additional benefit ( K > 0 pounds sterling ) , then the antidepressant group becomes more likely to be cost-effective . This likelihood is in excess of 90 % where decision makers are prepared to pay an additional 2,000 pounds sterling or more per additional patient with a good global outcome . The mean values for incremental net monetary benefits ( INMB ) from antidepressants are substantial for higher values of K ( INMB = 406 pounds sterling when K = 2,500 pounds sterling ) . CONCLUSION For a small proportion of patients , the counseling intervention ( as specified in this trial ) is a dominant cost-effective strategy . For a larger proportion of patients , the antidepressant intervention ( as specified in this trial ) is the dominant cost-effective strategy . For the remaining group of patients , cost-effectiveness depends on the value of K. Since we can not observe K , acceptability curves are a useful way to inform decision makers PURPOSE Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time . Clinical benefits , however , are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms . This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints . METHODS We undertook a group-r and omized controlled trial ( RCT ) of depression comparing intervention with usual care in 12 primary care practice s. Intervention practice s encouraged depressed patients to engage in active treatment , using nurses to provide regularly scheduled care management for 24 months . The study sample included 200 adults beginning a new depression treatment episode where patient presentation style could be identified .  Outpatient costs were defined as intervention plus outpatient treatment costs for the 2 years . Cost-offset analysis used general linear mixed models , 2-part models , and bootstrapping to test hypotheses regarding a differential intervention effect by patients ’ style , and to obtain 95 % confidence intervals for costs . RESULTS Intervention effects on outpatient costs over time differed by patient style ( P < .05 ) , result ing in a $ 980 cost decrease for depressed patients who complain of psychological symptoms and a $ 1,378 cost increase for depressed patients who complain of physical symptoms only . CONCLUSIONS Depression intervention for a 2-year period produced observable clinical benefit with decreased outpatient costs for depressed patients who complain of psychological symptoms . It produced limited clinical benefit with increased costs , however , for depressed patients who complain exclusively of physical symptoms , suggesting the need for developing new intervention approaches for this group CONTEXT Depression is a leading cause of disability worldwide , but treatment rates in primary care are low . OBJECTIVE To determine the cost-effectiveness from a societal perspective of 2 quality improvement ( QI ) interventions to improve treatment of depression in primary care and their effects on patient employment . DESIGN Group-level r and omized controlled trial conducted June 1996 to July 1999 . SETTING Forty-six primary care clinics in 6 community-based managed care organizations . PARTICIPANTS One hundred eighty-one primary care clinicians and 1356 patients with positive screening results for current depression . INTERVENTIONS Matched practice s were r and omly assigned to provide usual care ( n = 443 patients ) or to 1 of 2 QI interventions offering training to practice leaders and nurses , enhanced educational and assessment re sources , and either nurses for medication follow-up ( QI-meds ; n = 424 patients ) or trained local psychotherapists ( QI-therapy ; n = 489 ) . Practice s could flexibly implement the interventions , which did not assign type of treatment . MAIN OUTCOME MEASURES Total health care costs , costs per quality -adjusted life-year ( QALY ) , days with depression burden , and employment over 24 months , compared between usual care and the 2 interventions . RESULTS Relative to usual care , average health care costs increased $ 419 ( 11 % ) in QI-meds ( P = .35 ) and $ 485 ( 13 % ) in QI-therapy ( P = .28 ) ; estimated costs per QALY gained were between $ 15 331 and $ 36 467 for QI-meds and $ 9478 and $ 21 478 for QI-therapy ; and patients had 25 ( P = .19 ) and 47 ( P = .01 ) fewer days with depression burden and were employed 17.9 ( P = .07 ) and 20.9 ( P = .03 ) more days during the study period . CONCLUSIONS Societal cost-effectiveness of practice -initiated QI efforts for depression is comparable with that of accepted medical interventions . The intervention effects on employment may be of particular interest to employers and other stakeholders BACKGROUND Despite their impact on outcomes , the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied . This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence -based primary -care depression intervention . METHOD Twelve community primary -care practice s were stratified and then r and omized to enhanced ( intervention ) or usual care . Subjects included 211 patients beginning a new treatment episode for major depression . At baseline , 111 ( 52.6 % ) and 145 ( 68.7 % ) reported receptivity to antidepressant medication and counseling respectively . The intervention trained the primary -care teams to assess , educate , and monitor depressed patients . Twelve-month incremental ( enhanced minus usual care ) total costs and quality -adjusted life years ( QALYs ) were calculated . RESULTS Among patients receptive to antidepressants , the mean incremental cost-effectiveness ratio was dollar 5,864 per QALY ( sensitivity analyses up to dollar 14,689 per QALY ) . For patients not receptive to antidepressants , the mean incremental QALY score was negative ( for both main and sensitivity analyses ) , or the intervention was at least no more effective than usual care . CONCLUSIONS These findings suggest a re-thinking of the ' one size fits all ' depression intervention , given that half of depressed primary -care patients may be non-receptive to antidepressant medication treatment . A brief assessment of treatment receptivity should occur early in the treatment process to identify patients most likely to benefit from primary -care quality improvement efforts for depression treatment . Patient treatment preferences are also important for the development , design , and analysis of depression interventions BACKGROUND A course in coping with depression was reported to have documented effects in terms of shortening periods of depression . An economic evaluation of the course was conducted . MATERIAL S AND METHODS The estimate of medical effect derives from a r and omized controlled trial in 155 subjects with depression . On average subjects in the intervention group improved 3 - 4 points more on the  Beck Depression Inventory  than subjects in the control group . A value estimate is provided for this effect given what is known about the weight that society places on severity of illness and effect of treatment when prioritising among patient groups . The value estimate is compared with the costs of the course . RESULTS AND INTERPRETATION It is estimated that if 200 people take the course , the improvements in quality of life for all these people taken together may be regarded as equally valuable and worthy of priority as an intervention that provides an extra life year to one person . The cost of giving the course to 200 people is estimated at USD 45,000 - 60,000 . This is within the limits of what society is generally willing to pay in order to gain life years . Because of possible reductions in sick leave , societal net costs may be modest BACKGROUND This research study evaluates the effectiveness of a multifaceted intervention program to improve the management of  depression  in primary care . METHODS One hundred fifty-three primary care patients with current depression were entered into a r and omized controlled trial . Intervention patients received a structured depression treatment program in the primary care setting that included both behavioral treatment to increase use of adaptive coping strategies and counseling to improve medication adherence . Control patients received " usual " care by their primary care physicians . Outcome measures included adherence to antidepressant medication , satisfaction with care of depression and with antidepressant treatment , and reduction of depressive symptoms over time . RESULTS At 4-month follow-up , significantly more intervention patients with major and minor depression than usual care patients adhered to antidepressant medication and rated the quality of care they received for depression as good to excellent . Intervention patients with major depression demonstrated a significantly greater decrease in depression severity over time compared with usual care patients on all 4 outcome analyses . Intervention patients with minor depression were found to have a significant decrease over time in depression severity on only 1 of 4 study outcome analyses compared with usual care patients . CONCLUSION A multifaceted primary care intervention improved adherence to antidepressant regimens and satisfaction with care in patients with major and minor depression . The intervention consistently result ed in more favorable depression outcomes among patients with major depression , while outcome effects were ambiguous among patients with minor depression BACKGROUND We evaluated depression severity , health-related quality of life ( HRQL ) , and medical cost outcomes of primary care patients receiving recommended and less-than-recommended levels of antidepressant treatment .  METHODS We performed a secondary analysis of clinical trial data from primary care clinics in a staff-model managed care organization . The trial included patients with Diagnostic and Statistical Manual of Mental Disorders , Third Edition , Revised ( DSM-III-R ) criteria for major depression who were starting antidepressant treatment .  The primary outcomes measures used were the 17-item Hamilton Depression Rating Scale ( HDRS ) , Hopkins Symptom Checklist depression scores , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) mental and physical component summary scores , and the total outpatient and inpatient medical costs . RESULTS Of 358 patients starting antidepressant treatment , 195 ( 54.5 % ) received doses recommended by the Agency for Health Care Policy and Research for 90 days or more . Mean HDRS score decreased from 14.1 to 8.8 in patients receiving less-than-recommended treatment and decreased from 13.8 to 8.9 in patients with minimum recommended treatment ( P = .761 ) . No significant differences in improvement of HRQL outcomes during 6 months were observed between patients receiving recommended or less-than-recommended antidepressant therapy .  Mean total medical costs over 6 months for patients taking the recommended levels of antidepressant treatment were $ 1872 + /- 140 compared with $ 2622 + /- 413 for patients taking less-than-recommended treatment ( P = .032 ) . The differences in total medical costs were attributable to significantly lower nonmental health-related inpatient costs in the recommended antidepressant treatment group ( $ 104 vs $ 785 , P = .004 ) . CONCLUSIONS Patients receiving minimum recommended levels of antidepressant therapy for 3 months showed improvement in depression severity and HRQL comparable with patients receiving less-than-recommended treatment . Patients receiving minimum recommended treatment had lower total costs and nonmental health-related inpatient costs .  Antidepressant treatment in primary care patients may have the greatest impact on the frequency of health care visits and on costs for medical conditions and impairments Objective . Evaluate the incremental cost-effectiveness of a  depression relapse prevention program in primary care Material s and Methods . Primary care patients initiating antidepressant treatment completed a st and ardized telephone assessment 6–8 weeks later . Those recovered from the current episode but at high risk for relapse ( based on history of recurrent depression or dysthymia ) were offered r and omization to usual care or a relapse prevention intervention . The intervention included systematic patient education , two psychoeducational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and telephone and mail monitoring of medication adherence and depressive symptoms . Outcomes in both groups were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months and health plan cl aims and accounting data . Results . Intervention patients experienced 13.9 additional depression-free days during a 12-month period ( 95 % CI , −1.5 to 29.3 ) . Incremental costs of the intervention were $ 273 ( 95 % CI , $ 102 to $ 418 ) for depression treatment costs only and $ 160 ( 95 % CI , −$173 to $ 512 ) for total outpatient costs . Incremental cost-effectiveness ratio was $ 24 per depression-free day ( 95 % CI , −$59 to $ 496 ) for depression treatment costs only and $ 14 per depression-free day ( 95 % CI , −$35 to $ 248 ) for total outpatient costs . Conclusions . A program to prevent depression relapse in primary care yields modest increases in days free of depression and modest increases in treatment costs . These modest differences reflect high rates of treatment in usual care . Along with other recent studies , these findings suggest that improved care of depression in primary care is a prudent investment of health care re sources
Depression frequently causes unemployment , absenteeism , and presenteeism , which results in significantly reduced productivity .
Improving patients ' compliance with their antidepressant medication results in improved outcomes and prolongs remission from depression , increasing work productivity , and thus reducing overall costs .
The implementation of remote enhanced-care programs may improve compliance and reduce overall costs .
In conclusion , depression is a common disorder with a high economic impact .
Enhanced-care programs may lower costs associated with depression and improve patients ' lives
This systematic review examines the economic and human costs of depression and the potential savings associated with improvement in patient adherence to treatment with antidepressants through the use of enhanced-care programs .