| Titre : | Cost-effectiveness of practice-initiated quality improvement for Depression : Results of a randomized controlled trial. (2001) |
| Auteurs : | Michael SCHOENBAUM ; Maureen-F CARNEY ; Naihua DUAN ; Lisa-S MEREDITH ; Jeanne MIRANDA ; Lisa-V RUBENSTEIN ; Cathy SHERBOURNE ; Jurgen UNUTZER ; Kenneth WELLS ; Ucla-Neuropsychiatric Institute. University of California. Los Angeles. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 286, n° 11, 2001) |
| Pagination : | 1325-1330 |
| Langues: | Anglais |
| Mots-clés : | Etat dépressif ; Analyse coût efficacité ; Economie santé ; Qualité vie ; Thérapeutique ; Pronostic ; Homme ; Trouble humeur |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 5CR0xPC7. Diffusion soumise à autorisation]. 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 randomized 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 practices were randomly 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 resources, and either nurses for medication follow-up (QI-meds ; n=424 patients) or trained local psychotherapists (QI-therapy ; n=489). Practices 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 Ql-meds (P=35) and $485 (13%) in QI-therapy (P=28) ; estimated costs per QALY gained were between $15331 and $36467 for QI-meds and $9478 and $21478 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 Ql efforts for depression is comparable with that of accepted medical interventions. (...) |
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