Cost-effectiveness considerations for managed care systems: Treating depression in primary care

This article addresses the management of depression in primary care from the perspective of a health maintenance organization. The rise of managed care systems is briefly discussed with reference to their impact on choice of treatment strategies. Cost-effectiveness considerations pertinent to a health maintenance organization are reviewed. A simplified protocol for the treatment of depression with paroxetine or imipramine in the primary care sector is presented and used as an example of cost calculations. Given the assumptions used in this cost-effectiveness model, it appears that the costs of treating depression in primary care with paroxetine are approximately equal to those found with the use of imipramine. Higher acquisition costs of paroxetine are balanced by the greater labor costs associated with imipramine.