One of a cluster of five papers on depression in this issue of Annals, this study provides the first evidence that depression disease management produces increasingly better outcomes over time, while at the same time becoming less costly.

For the study, practices providing enhanced care management supplemented acute care with systematic monitoring for two years, encouraging depressed patients to engage in active treatment and using practice nurses to provide regular care management.

Analyzing the outcomes for 221 adults beginning treatment for major depression, the authors found that enhanced care significantly increased the number of days free of depression impairment for two years when compared to usual care (623 days vs. 527 days). The incremental cost-effectiveness ratio for enhanced care ranged from $5,054 to $8,073 per quality-adjusted life year.

In their analysis, the authors point out that incremental quality-adjusted life years significantly increased with time while incremental costs declined. They conclude that enhanced management of depression in primary care is cost-effective and appears to be an efficient use of health care resources, and they assert that their findings should encourage health plans to provide for long- rather than short-term depression management.

They note that primary care depression management results in comparable or greater cost-effectiveness than smoking cessation counseling, hypertension treatment, cholesterol treatment or chronic obstructive pulmonary disease rehabilitation.

Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis By Kathryn Rost, Ph.D., et al

Angela Lower - alower@aafp.org American Academy of Family Physicians

January/February Annals of Family Medicine tip sheet

Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline. Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Practice, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the North American Primary Care Research Group. The journal is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. A board of directors with representatives from each of the sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups can be accessed free of charge on the journal's Web site, American Academy of Family Physicians.

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