Cost-effectiveness of Systematic Depression Treatment for High Utilizers of General Medical Care

Abstract
DESPITE the prevalence1,2 and effect3,4 of depression in primary care, current management often falls short of recommended standards.5-8 Several randomized trials during the last decade demonstrate that organized treatment programs significantly improve the quality and outcomes of primary care depression treatment. Schulberg et al9 demonstrated that depression screening followed by guideline-based pharmacotherapy or psychotherapy significantly improved outcomes compared with usual care. Katon et al10-12 have described 3 models of collaborative care (shared management by primary care physicians and consulting psychiatrists or psychologists) that significantly improved both quality of depression treatment and clinical outcomes. Mynors-Wallis et al13 have demonstrated the effectiveness of brief, structured psychotherapy provided in primary care. We have recently described the effectiveness of a population-based depression screening and treatment program for high utilizers of medical care.14