title: Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression.
abstract: OBJECTIVE
  The report estimates the treatment costs, cost-offset effects, and cost-effectiveness of Collaborative Care of depressive illness in primary care.
  
  
  METHODS
  Treatment costs, cost-offset effects, and cost-effectiveness were assessed in two randomized, controlled trials. In the first randomized trail (N = 217), consulting psychiatrists provide enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence. In the second randomized trial (N = 153). Collaborative Care was implemented through brief cognitive-behavioral therapy and enhanced patient education. Consulting psychologist provided brief psychotherapy supplemented by educational materials and enhanced pharmacotherapy management.
  
  
  RESULTS
  Collaborative Care increased the costs of treating depression largely because of the extra visits required to provide the interventions. There was a modest cost offset due to reduced use of specialty mental health services among Collaborative Care patients, but costs of ambulatory medical care services did not differ significantly between the intervention and control groups. Among patients with major depression there was a modest increase in cost-effectiveness. The cost per patient successfully treated was lower for Collaborative Care than for Usual Care patients. For patients with minor depression. Collaborative Care was more costly and not more cost-effective than Usual Care.
  
  
  CONCLUSIONS
  Collaborative Care increased depression treatment costs and improved the cost-effectiveness of treatment for patients with major depression. A cost offset in specialty mental health costs, but not medical care costs, was observed. Collaborative Care may provide a means of increasing the value of treatment services for major depression.
authors.affiliation: Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101, USA.
authors.forename: M
authors.initials: M
authors.lastname: Von Korff
authors.forename: W
authors.initials: W
authors.lastname: Katon
authors.forename: T
authors.initials: T
authors.lastname: Bush
authors.forename: E H
authors.initials: EH
authors.lastname: Lin
authors.forename: G E
authors.initials: GE
authors.lastname: Simon
authors.forename: K
authors.initials: K
authors.lastname: Saunders
authors.forename: E
authors.initials: E
authors.lastname: Ludman
authors.forename: E
authors.initials: E
authors.lastname: Walker
authors.forename: J
authors.initials: J
authors.lastname: Unutzer
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics; D019090:Case Management / Q000191:economics* / Q000592:standards; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008605:Mental Health Services / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D011614:Psychotherapy, Brief / Q000191:economics; D012017:Referral and Consultation / Q000191:economics / Q000592:standards; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents