Cost-Effectiveness of a Collaborative Care Program for Primary Care Patients With Persistent Depression

Gregory E. Simon · Wayne J. Katon · Michael VonKorff · Jürgen Unützer · Elizabeth H.B. Lin · Edward A. Walker +3 more

328 citations0/0 files storedAmerican Journal of Psychiatry

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Mental Health Treatment and Access Health Systems, Economic Evaluations, Quality of Life Treatment of Major Depression

Abstract

OBJECTIVE: The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management. METHOD: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks after the initial prescription. Those with persistent major depression or significant subthreshold depressive symptoms were randomly assigned to continued usual care or collaborative care. The collaborative care included systematic patient education, an initial visit with a consulting psychiatrist, 2-4 months of shared care by the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Clinical outcomes were assessed through blinded telephone assessments at 1, 3, and 6 months. Health services utilization and costs were assessed through health plan claims and accounting data. RESULTS: Patients receiving collaborative care experienced a mean of 16.7 additional depression-free days over 6 months. The mean incremental cost of depression treatment in this program was $357. The additional cost was attributable to greater expenditures for antidepressant prescriptions and outpatient visits. No offsetting decrease in use of other health services was observed. The incremental cost-effectiveness was $21.44 per depression-free day. CONCLUSIONS: A stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs. These findings are consistent with those of other randomized trials. Improving outcomes of depression treatment in primary care requires investment of additional resources, but the return on this investment is comparable to that of many other widely accepted medical interventions.

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1996Cost-Effectiveness in Health and Medicine 1989The functioning and well-being of depressed patients. Results from the Medical Outcomes Study 1994Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study 1995Collaborative management to achieve treatment guidelines. Impact on depression in primary care 1995Social consequences of psychiatric disorders, I: Educational attainment 1995Five‐Hundred Life‐Saving Interventions and Their Cost‐Effectiveness 2015The Hopkins Symptom Checklist (HSCL)1996A Multifaceted Intervention to Improve Treatment of Depression in Primary Care

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