Cost-utility analysis in depression: The McSad utility measure for depression health states

Cost-utility analysis, used increasingly over the past decade to analyze co sts and effects in treating physical diseases, has received little attentio n in psychiatry. This article briefly introduces the concepts and methods o f utility measurement and illustrates it using depression as an example. Th e authors describe the McSad health state classification system for depress ion, a direct utility measure for depression, and report results of an appl ication of McSad among 105 patients who had a recent history of depression. Utility measures express patient preferences for specific health states on a scale ranging from 0, representing death, to 1, representing perfect hea lth. These scores provide the weights used to calculate the number of quali ty-adjusted Life-years gained by an intervention or set-vice. McSad allows a patient's depression health state to be classified according to level of functioning in six dimensions of depression and to be compared with other h ypothetical depression health states in order to produce utility scores ind icating the patient's relative preferences.