title: Cost-effectiveness of improving primary care treatment of late-life depression.
abstract: BACKGROUND
  Depression is a leading cause of functional impairment in elderly individuals and is associated with high medical costs, but there are large gaps in quality of treatment in primary care.
  
  
  OBJECTIVE
  To determine the incremental cost-effectiveness of the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.
  
  
  METHODS
  Randomized controlled trial with recruitment from July 1999 to August 2001.
  
  
  METHODS
  Eighteen primary care clinics from 8 health care organizations in 5 states.
  
  
  METHODS
  A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).
  
  
  METHODS
  Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual primary care (n = 895). Intervention patients were provided access to a depression care manager supervised by a psychiatrist and primary care physician. Depression care managers offered education, support of antidepressant medications prescribed in primary care, and problem-solving treatment in primary care (a brief psychotherapy).
  
  
  METHODS
  Total outpatient costs, depression-free days, and quality-adjusted life-years.
  
  
  RESULTS
  Relative to usual care, intervention patients experienced 107 (95% confidence interval [CI], 86 to 128) more depression-free days over 24 months. Total outpatient costs were USD $295 (95% CI, -$525 to $1115) higher during this period. The incremental outpatient cost per depression-free day was USD $2.76 (95% CI, -$4.95 to $10.47) and incremental outpatient costs per quality-adjusted life-year ranged from USD $2519 (95% CI, -$4517 to $9554) to USD $5037 (95% CI, -$9034 to $19 108). Results of a bootstrap analysis suggested a 25% probability that the IMPACT intervention was "dominant" (ie, lower costs and greater effectiveness).
  
  
  CONCLUSIONS
  The IMPACT intervention is a high-value investment for older adults; it is associated with high clinical benefits at a low increment in health care costs.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA 98195, USA. wkaton@u.washington.edu
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.forename: Enid
authors.initials: E
authors.lastname: Hunkeler
authors.forename: Linda
authors.initials: L
authors.lastname: Harpole
authors.forename: Xiao-Hua Andrew
authors.initials: XH
authors.lastname: Zhou
authors.forename: Christopher
authors.initials: C
authors.lastname: Langston
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods; D003865:Major Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000191:economics; D011788:Quality of Life; D016896:Treatment Outcome