CONTEXT: Depression is a leading cause of disability worldwide, but treatment rates are low, particularly for minority patients.
OBJECTIVE: To estimated societal cost-effectiveness of two interventions to improve care for depression in primary care, examining Latino and white patients separately.
METHODS: Intent-to-treat analysis of data from a group-level controlled trial, in which matched primary care clinics in the US were randomized to usual care or to one of two interventions designed to increase the rate of effective depression treatment. One intervention facilitated medication management ("QI-Meds") and the other psychotherapy ("QI-Therapy"); but patients and clinicians could choose the type of treatment, or none. The study involved 46 clinics in 6 non-academic, managed care organizations; 181 primary care providers; and 398 Latino and 778 White patients with current depression. Outcomes are health care costs, quality-adjusted life years (QALY), depression burden, employment, and costs per QALY, over 24 months of follow-up.
RESULTS: Relative to usual care, QI-Therapy resulted in significantly fewer depression burden days for Latinos and increased days employed for white patients. Average health care costs increased 278 dollars in QI-Meds and 161 dollars in QI-Therapy for Latinos, and by 655 dollars in QI-Meds and 752 dollars in QI-Therapy for whites, relative to usual care. The estimated cost per QALY for Latinos was 6,100 dollars or less under QI-Therapy, but 90,000 dollars or more in QI-Meds. For Whites, estimated costs per QALY were around 30,000 dollars under both interventions.
CONCLUSIONS: Latinos benefit from improved care for depression, and the cost is less than that for white patients. Diverse patients are likely to benefit from improving care for depression in primary care.
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