Cost-Effectiveness of Collaborative Care for Depression in a Primary Care Veteran Population

Department of Health Services, University of Washington Seattle, Seattle, Washington, United States
Psychiatric Services (Impact Factor: 1.99). 06/2003; 54(5):698-704. DOI: 10.1176/
Source: PubMed

ABSTRACT This study examined the incremental cost-effectiveness of a collaborative care intervention for depression compared with consult-liaison care.
A total of 354 patients in a Department of Veterans Affairs (VA) primary care clinic who met the criteria for major depression or dysthymia were randomly assigned to one of the two care models. Under the collaborative care model, a mental health team provided a treatment plan to primary care providers, telephoned patients to encourage adherence, reviewed treatment results, and suggested modifications. Outcomes were assessed at three and nine months by telephone interviews. Health care use and costs were also assessed.
A significantly greater number of collaborative care patients were treated for depression and given prescriptions for antidepressants. The collaborative care patients experienced an average of 14.6 additional depression-free days over the nine months. The mean incremental cost of the intervention per patient was $237 US dollars for depression treatment and $519 US dollars for total outpatient costs. A majority of the additional expenditures were accounted for by the intervention. The incremental cost-effectiveness ratio was $24 US dollars per depression-free day for depression treatment costs and $33 US dollars for total outpatient cost.
Better coordination and communication under collaborative care was associated with a greater number of patients being treated for depression and with moderate increases in days free of depression and in treatment cost. Additional resources are needed for effective collaborative care models for depression treatment in primary care.

  • Source
    • "Despite this difference, out findings are surprisingly consistent with analyses from the IMPACT study (Katon et al., 2005), which at 24 months found that the depression intervention was associated with lower outpatient mental health costs, but no difference in total outpatient or overall total costs. Our results are also relatively consistent with Liu and colleagues (Liu, et al, 2003) who also enhanced usual care but still found higher behavioral health costs associated with the integrated intervention side, although these differences were likely not statistically significant. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veteran's Affairs and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p<0.05) behavioral health costs. Differences in other types of services use were detected.
    Ageing International 06/2008; 32(2):108-127. DOI:10.1007/s12126-008-9010-7
  • Source
    • "atistical measures of outcomes into a clinically meaningful context . Estimating DFDs from depression severity scores has been used in several trials of depression treatment as a means of determining clinical significance ( Araya , Flynn , Rojas , Fritsch , & Simon , 2006 ; Ciechanowski et al . , 2006 ; Lave , Frank , Schulberg , & Kamlet , 1998 ; Liu et al . , 2003 ; Lynch et al . , 2005 ; Mallick , Chen , Entsuah , & Schatzberg , 2003 ; Montgomery & Andersen , 2006 ; Pyne , Tripathi , Williams , & Fortney , 2007 ; Revicki et al . , 2005 ; Simon et al . , 2001 , 2002 ; Trivedi et al . , 2004 ) . Further , DFDs are directly related to quality - adjusted life years , and thus they can also serve as "
    [Show abstract] [Hide abstract]
    ABSTRACT: We compared a primary-care-based psychotherapy, that is, problem-solving therapy for primary care (PST-PC), to community-based psychotherapy in treating late-life major depression and dysthymia. The data here are from the IMPACT study, which compared collaborative care within a primary care clinic to care as usual in the treatment of 1,801 primary care patients, 60 years of age or older, with major depression or dysthymia. This study is a secondary data analysis (n = 433) of participants who received either PST-PC (by means of collaborative care) or community-based psychotherapy (by means of usual care). Older adults who received PST-PC had more depression-free days at both 12 and between 12 and 24 months (beta = 47.5, p <.001; beta = 47.0, p <.001), and they had fewer depressive symptoms and better functioning at 12 months (beta(dep) = -0.36, p <.001; beta(func) = -0.94, p <.001), than those who received community-based psychotherapy. We found no differences at 24 months. Results suggest that PST-PC as delivered in primary care settings is an effective method for treating late-life depression.
    The Gerontologist 06/2008; 48(3):311-23. DOI:10.1093/geront/48.3.311 · 3.21 Impact Factor
  • Source
    • "Integrated mental health care has yielded a number of significant service as well as patient outcomes. Integrated care is associated with increased mental health care access and rates of treatment (Bartels et al., 2004; Hedrick et al., 2003; Liu et al., 2003), improved treatment adherence (Katon et al., 1999; Katon et al., 2002; Roy-Byrne et al., 2001), enhanced clinical and functional outcomes (Katon et al., 2002; Rollman et al., 2005; Roy-Byrne et al., 2001; Unützer et al., 2002), and greater cost-effectiveness (Liu et al., 2003). This is only a capsule view of the literature on the value of the integration of mental health services into the primary care setting. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation's largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA's efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients.
    Journal of Clinical Psychology in Medical Settings 04/2008; 15(1):73-8. DOI:10.1007/s10880-008-9100-4 · 1.49 Impact Factor
Show more