Cost-effectiveness of collaborative care for depression in a primary care veteran population.
OBJECTIVE
This study examined the incremental cost-effectiveness of a collaborative care intervention for depression compared with consult-liaison care.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA. chuan-fen.liu@med.va.gov
Chuan-Fen
CF
Liu
Susan C
SC
Hedrick
Edmund F
EF
Chaney
Patrick
P
Heagerty
Bradford
B
Felker
Nicole
N
Hasenberg
Stephan
S
Fihn
Wayne
W
Katon
D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology*; D014861:Washington