Skip Navigation LinksHome > December 2004 - Volume 42 - Issue 12 > Disease Management Programs for Depression: A Systematic Rev...
Medical Care:
Original Article

Disease Management Programs for Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Neumeyer-Gromen, Angela MD, MPH*; Lampert, Thomas Dipl-Soz†; Stark, Klaus MD, PhD†; Kallischnigg, Gerd Dipl-Math‡

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Abstract

Background: Substantial deficits in the care of depression make the provision of new evidence-based care models a matter of increasing importance. So far, disease management programs (DMPs) have not been systematically assessed.

Objective: This study was a systematic review and meta-analysis of randomized controlled trials investigating the effectiveness of DMP for depression as compared with usual primary care.

Methods: Criteria for study selection were depression as main diagnosis in adults, the intervention DMP (evidence-based guidelines, patient/provider education, collaborative care, reminder systems, and monitoring), and trial quality A/B (Cochrane Collaboration guidelines) rated by 2 observers. Measurement instruments had to be published in peer-reviewed journals and filled out by the participants, their relations, or independent raters. Meta-analyses were conducted by using dichotomous outcomes within forest plots. Tests of heterogeneity, sensitivity analyses, and funnel plots were performed. Economic evaluations were descriptively summarized.

Results: DMP had a significant effect on depression severity, with a relative risk of 0.75 (95% confidence interval 0.70–0.81) in a homogeneous dataset of 10 high-quality trials. It was robust in all sensitivity analyses (evidence level 1A). Funnel plot symmetry indicated a low probability of publication bias. Patient satisfaction and adherence to the treatment regimen improved significantly, but only in heterogeneous models. The costs per quality adjusted life year ranged between $9,051 and $49,500.

Conclusion: DMP significantly enhance the quality of care for depression. Costs are within the range of other widely accepted public health improvements. Future research should focus on the effect of long-term interventions, and the compatibility with health care systems other than managed-care driven ones.

© 2004 Lippincott Williams & Wilkins, Inc.

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