title: Long-term cost effects of collaborative care for late-life depression.
abstract: 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.
authors.affiliation: 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
authors.forename: Jurgen
authors.initials: J
authors.lastname: Unutzer
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: Michael C
authors.initials: MC
authors.lastname: Schoenbaum
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Richard D
authors.initials: RD
authors.lastname: Della Penna
authors.forename: Diane
authors.initials: D
authors.lastname: Powers
mesh_terms: 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