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The Cost–Utility of Screening for Depression in Primary Care

Marcia Valenstein, MD, MS; Sandeep Vijan, MD, MS; John E. Zeber, MHA; Kathryn Boehm, MD, MS; and Amna Buttar, MD, MS
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From Health Services Research and Development, Veterans Affairs Ann Arbor Health System, and University of Michigan, Ann Arbor, Michigan; and The Medical College of Ohio, Toledo, Ohio.

Acknowledgments: The authors thank Drs. Hayward, Katz, Klinkman, Mellow, and Nease for review and comments on earlier drafts of this manuscript.

Grant Support: By Department of Veterans Affairs Health Services Research and Development Career Development Award RC-98350-1; the Department of Veterans Affairs Center for Practice Outcomes and Management; and the Serious Mental Illness Treatment and Evaluation Center, Ann Arbor, Michigan.

Requests for Single Reprints: Marcia Valenstein, MD, MS, Health Services Research and Development, Department of Veterans Affairs Medical Center, Box 130170, Ann Arbor, MI 48113-0170.

Current Author Addresses: Drs. Valenstein and Vijan and Mr. Zeber: Health Services Research and Development, Department of Veterans Affairs Medical Center, Box 130170, Ann Arbor, MI 48113-0170.

Dr. Boehm: Medical College of Ohio, Adolescent and Young Adult Health Services, 2222 Cherry Street, Suite 2600, Toledo, OH 43608.

Dr. Buttar: Department of Medicine, Division of General Medicine and Geriatrics, Indiana University, Wishard Health Sciences, OPW-M200, 1001 West Tenth Street, Indianapolis, Indiana 46202.

Author Contributions: Conception and design: M. Valenstein, S. Vijan, J.E. Zeber, K. Boehm, A. Buttar.

Analysis and interpretation of the data: M. Valenstein, S. Vijan, J.E. Zeber, K. Boehm, A. Buttar.

Drafting of the article: M. Valenstein.

Critical revision of the article for important intellectual content: M. Valenstein, S. Vijan, J.E. Zeber, K. Boehm.

Final approval of the article: M. Valenstein, S. Vijan, J.E. Zeber, K. Boehm.

Provision of study materials or patients: K. Boehm.

Statistical expertise: S. Vijan, J.E. Zeber.

Administrative, technical, or logistic support: J.E. Zeber.

Collection and assembly of data: K. Boehm, A. Buttar.

Ann Intern Med. 2001;134(5):345-360. doi:10.7326/0003-4819-134-5-200103060-00007
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Major depressive disorder is a serious, debilitating, and costly illness. Five percent to 12% of men and 10% to 25% of women have a major depressive episode during their lifetime, and many more have depressive disorders that fall short of criteria for major depressive disorder (12). Depressive disorders are associated with functional impairment, decreased productivity, increased health care utilization, and increased risk for suicide (313). In the United States, the direct and indirect costs of depression are estimated to be $43.7 billion per year (14).

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Estimated distribution of the cost–utility ratio of annual screening for depression.

Data were obtained by performing 3500 Monte Carlo simulations. In 21% of the 3500 simulations, no screening was dominant over annual screening (that is, it was more effective and less costly); these results are not shown in the figure. When all of the simulations were considered, only 2.2% produced cost–utility ratios less than $50 000/QALY.

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Summary for Patients

The Cost-Effectiveness of Screening Primary Care Patients for Depression

The summary below is from the full report titled “The Cost–Utility of Screening for Depression in Primary Care.” It is in the 6 March 2001 issue of Annals of Internal Medicine (volume 134, pages 345-360). The authors are M Valenstein, S Vijan, JE Zeber, K Boehm, and A Buttar.


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