COST-EFFECTIVENESS OF TREATMENTS FOR MAJOR DEPRESSION IN PRIMARY-CAREPRACTICE

Background: This study augments a randomized controlled trial to analy ze the cost-effectiveness of 2 standardized treatments for major depre ssion relative to each other and to the ''usual care'' provided by pri mary care physicians. Methods: A randomized controlled trial was condu cted in which primary care patients meeting DSM-III-R criteria for cur rent major depression were assigned to pharmacotherapy (where nortript yline hydrochloride was given) or interpersonal psychotherapy provided in a standardized framework or a primary physician's usual care. Two outcome measures, depression-free days and quality-adjusted days, were developed using information on depressive symptoms over time. The cos ts of care were calculated. Cost-effectiveness ratios comparing the in cremental outcomes with the incremental costs for the different treatm ents were estimated. Sensitivity analyses were performed. Results: In terms of both economic costs and quality-of-life outcomes, patients as signed to the pharmacotherapy group did slightly better than those ass igned to interpersonal psychotherapy. Both standardized therapies prov ided better outcomes than primary physician's usual care, but each con sumed more resources. No meaningful cost-offsets were found. The incre mental direct cost per additional depression-free day for pharmacother apy relative to usual care ranges from $12.66 to $16.87 which translat es to direct cost per quality-adjusted year gained from $11 270 to $19 510. Conclusions: Standardized treatments for depression lead to bett er outcomes than usual care but also lead to higher costs. However, th e estimates of the cost per quality-of-life year gained for standardiz ed pharmacotherapy are comparable with those found for other treatment s provided in routine practice.