• Judith Bosmans, Martine de Bruijne, Hein van Hout, Harm van Marwijk, Aartjan Beekman, Lex Bouter, Wim Stalman, and Maurits van Tulder.
• Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands. judith.bosmans@falw.vu.nl
• J Gen Intern Med. 2006 Oct 1; 21 (10): 1020-6.

BackgroundMajor depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care.ObjectiveTo evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care.DesignEconomic evaluation alongside a cluster randomized-controlled trial.ParticipantsConsecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis.InterventionsGeneral practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way.MeasurementsSeverity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs.ResultsDifferences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups.ConclusionsThis disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.

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