Is conformity to depression treatment guidelines associated with reduced health services costs?

Aim: The objectives of this study were: (1) to assess the conformity of current treatment to the Canadian guidelines for pharmacological treatment of depression, (2) to determine whether there is a difference in costs of health care services by level of conformity to guidelines and (3) to identify patients’ and treating physician characteristics that could be associated with treatment conformity level and that could explain differences in costs. Methods: A population-based retrospective drug utilization review was performed. Using data from the Quebec Health Insurance Board (Canada) we identified 2750 adults who had received a diagnosis of depression and a prescription for psychotropic medication. Conformity to prescribing guidelines was defined by the type of medication, dosage and duration of treatment. The cost of health services was measured in terms of physician services, hospitalizations and medications. Results: Only 12.7% of patients were treated according to all criteria of the practice guidelines. Compared to the non conformity group of patients, those given guideline-concordant treatment generated higher costs for visits to their prescribing physician and for medication, but lower costs for visits to other physicians and to the emergency room. No savings were shown for other services or overall cost. Patients’ and treating physician characteristics varied by treatment conformity level. Conclusion: The pharmacological treatment of depression is suboptimal. Treating depressed patients according to prescribing guidelines is not associated with savings overall. Prat Organ Soins. 2010;41(4):349-357