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Standardized treatments for depression lead to better outcomes than usual care but also lead to higher costs. However, the estimates of the cost per quality-of-life year gained for standardized pharmacotherapy are comparable with those found for other treatments provided in routine practice.

Background. Health-state preferences can be combined with willingness-to-pay (WTP) data to calculate WTP per qualityadjusted life year (QALY). The WTP/QALY ratios provide insight into societal valuations of expenditures for medical interventions. Methods. The authors measured preferences for current health in 3 patient populations (N = 391) using standard gamble, time trade-off, visual analog scale, and WTP, then they calculated WTP/QALY ratios. The ratios were compared with several proposed cost/QALY cost-effectiveness ratio thresholds, the value-of-life literature, and with WTP/ QALY ratios derived from published preference research. Results. Mean WTP/QALY ratios ranged from $12,500 to $32,200 (2003 $US). All values were below most published cost-effectiveness ratio thresholds, below the ratio from a pro-totypic medical treatment covered by Medicare (i.e., renal dialysis), and below ratios from the value-of-life literature. The WTP/QALY ratios were similar to those calculated from published preference data for patients with symptomatic menopause, dentofacial deformities, asthma, or dermatologic disorders. Conclusions. WTP/QALY ratios calculated using preference data collected from diverse populations are lower than most proposed thresholds for determining what is "costeffective." Current proposed cost-effectiveness ratio thresholds may overestimate the willingness of society to pay for medical interventions.

Background Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the impact of these clinics on costs, quality, and delivery of preventive care. Objective To address these concerns, we compared the care for three acute conditions at retail clinics and other care settings. Setting Enrollees of a large Minnesota health plan Patients Enrollees who received care for otitis media, pharyngitis, or urinary tract infection (UTI) Design We aggregated 2005–2006 claims data from a large health plan into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After identifying 2100 episodes (700 each) in which otitis media, pharyngitis, and UTI were treated first in retail clinics, we matched them with episodes in which these illnesses were treated first in physician offices, urgent care clinics and emergency departments. Measurements Costs per episode, performance on 14 quality indicators, receipt of 7 preventive care services at the initial appointment or subsequent 3 months. Results Overall costs of care for episodes initiated at retail clinics were substantially lower than matched episodes initiated at physician offices, urgent care clinics, and emergency departments ($110 vs. $166, $156, $570 respectively, p<0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care clinics ($21, $21, $22), as were aggregate quality scores (63.6%, 61.0%, 62.6%), and patient’s receipt of preventive care (14.5%, 14.2%, 13.7%) (p>0.05 for comparisons with retail clinics). At emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower. Limitations Analyzing claims data limits the number of quality measures and preventive care services studied. Despite matching, patients at different care sites might differ in their severity of illness. Conclusions Compared to physician offices and urgent care clinics, retail clinics provide less costly treatment for three common illnesses, with no apparent adverse impact on quality of care or delivery of preventive care. Funding California HealthCare Foundation

Both moderate-intensity and high-intensity guideline implementation strategies safely increased the proportion of low-risk patients with pneumonia who were treated as outpatients. The high-intensity strategy was most effective for increasing the performance of the recommended processes of care for outpatients and inpatients.