Journal of General Internal Medicine

, Volume 18, Issue 6, pp 432–441 | Cite as

Cost-effectiveness of a primary care depression intervention

  • Jeffrey M. PyneEmail author
  • Lathryn M. Rost
  • Mingliang Zhang
  • D. Keith Williams
  • Jeffrey Smith
  • John Fortney
Original Articles


OBJECTIVE: To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care.

DESIGN: Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months.

SETTING: Primary care practices located in 10 states across the United States.

PATIENTS/PARTICIPANTS: Two hundred eleven patients beginning a new treatment episode for major depression.

INTERVENTIONS: Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year.

MEASUREMENTS AND MAIN RESULTS: Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was $15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from $11,341 (using geographic block variables to control for pre-intervention service utilization) to $19,976 (increasing the cost estimates by 50%) per QALY.

CONCLUSIONS: This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation.

Key words

cost-benefit analysis depression quality of life primary health care 


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Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Jeffrey M. Pyne
    • 1
    • 2
    Email author
  • Lathryn M. Rost
    • 4
  • Mingliang Zhang
    • 2
  • D. Keith Williams
    • 3
  • Jeffrey Smith
    • 4
  • John Fortney
    • 1
    • 2
  1. 1.Received from the HSRD Center for Mental Healthcare and Outcomes ResearchCentral Arkansas Veterans Healthcare SystemLittle Rock
  2. 2.the Department of PsychiatryUniversity of Arkansas for Medical SciencesLittle Rock
  3. 3.Department of BiometryUniversity of Arkansas for Medical SciencesLittle Rock
  4. 4.the Department of Family MedicineUniversity of Colorado Health Sciences CenterDenver

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