The University of Pittsburgh is conducting a randomized clinical trial """"""""Transferring Care from the Specialist Settings"""""""" (MH-45815) in which it will compare the efficacy of two depression specific treatments (nortriptyline and interpersonal psychotherapy) provided in the primary care settings with that of usual care. We propose to conduct a cost effectiveness analyses of these treatments. For each study patient we will determine (through medical record reviews at the primary care center, information kept by research team and through personal interviews) patterns of health services utilization conducted for the 3 months prior to assignment to a depression treatment and for the subsequent 18 months. The health assessments for the patients will be conducted at months 12 and 18. The costs of health service used will be determined by using Blue Shield prevailing payment rates for ambulatory care services and estimated costs for emergency room and inpatient care. A general model of health care utilization and costs will be developed. This model will be estimated using multivariate statistical techniques with particular use of ordinary least squares as well as logit analyses. Particular attention will be given to the impact of applying depression specific treatments on the use and costs of general medical services (the offset effect). The effect of treatments on outcomes will be examined for months 0-8 principally, but not exclusively, under MH-45815 and for months 12 and 18 under this proposal. Survival analysis will be used to determine the effect of treatment on health status. We will then compare the cost effectiveness of the depression treatments in which the increased in health services costs (treatment costs minus offsets are compared to the improvements in health status.
