Long-term cost effects of collaborative care for late-life depression.
OBJECTIVE
To determine the long-term effects on total healthcare costs of the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) program for late-life depression compared with usual care.


METHODS
Randomized controlled trial with enrollment from July 1999 through August 2001. The IMPACT trial, conducted in primary care practices in 8 delivery organizations across the United States, enrolled 1801 depressed primary care patients 60 years or older. Data are from the 2 IMPACT sites for which 4-year cost data were available. Trial enrollment across these 2 health maintenance organizations was 551 patients.


METHODS
Participants were randomly assigned to the IMPACT intervention (n = 279) or to usual primary care (n = 272). Intervention patients had access to a depression care manager who provided education, behavioral activation, support of antidepressant medication management prescribed by their regular primary care provider, and problem-solving treatment in primary care for up to 12 months. Care managers were supervised by a psychiatrist and a primary care provider. The main outcome measures were healthcare costs during 4 years.


RESULTS
IMPACT participants had lower mean total healthcare costs ($29 422; 95% confidence interval, $26 479-$32 365) than usual care patients ($32 785; 95% confidence interval, $27 648-$37 921) during 4 years. Results of a bootstrap analysis suggested an 87% probability that the IMPACT program was associated with lower healthcare costs than usual care.


CONCLUSIONS
Compared with usual primary care, the IMPACT program is associated with a high probability of lower total healthcare costs during a 4-year period.
Unutzer
Jurgen
J
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, 1959 NE Pacific St, Seattle, WA 98195-6560, USA. unutzer@u.washington.edu
Katon
Wayne J
WJ
Fan
Ming-Yu
MY
Schoenbaum
Michael C
MC
Lin
Elizabeth H B
EH
Della Penna
Richard D
RD
Powers
Diane
D
D000367:Age Factors; D000368:Aged; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003863:Depression / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010821:Physicians, Family; D011320:Primary Health Care / Q000191:economics*; D015397:Program Evaluation; D013997:Time Factors