• Jeffrey M Pyne, Kathryn M Rost, Mingliang Zhang, D Keith Williams, Jeffrey Smith, and John Fortney.
• HSRD Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 72114-1706, USA. pynejeffreym@uams.edu
• J Gen Intern Med. 2003 Jun 1; 18 (6): 432441432-41.

ObjectiveTo determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care.DesignFollowing stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months.SettingPrimary care practices located in 10 states across the United States.Patients/ParticipantsTwo hundred eleven patients beginning a new treatment episode for major depression.InterventionsTraining 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 ResultsCost-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 US dollars 15463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from US dollars 11341 (using geographic block variables to control for pre-intervention service utilization) to US dollars 19976 (increasing the cost estimates by 50%) per QALY.ConclusionsThis 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.

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