title: Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial.
abstract: BACKGROUND
  Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAMcare) compared with usual primary care (UC) in outpatients with depression and poorly controlled diabetes or CHD.
  
  
  METHODS
  Randomized controlled trial of a systematic care management program aimed at improving depression scores and hemoglobin A(1c) (HbA(1c)), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels.
  
  
  METHODS
  Fourteen primary care clinics of an integrated health care system.
  
  
  METHODS
  Population-based screening identified 214 adults with depressive disorder and poorly controlled diabetes or CHD.
  
  
  METHODS
  Physician-supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk factors.
  
  
  METHODS
  Blinded assessments evaluated depressive symptoms, SBP, and HbA(1c) at baseline and at 6, 12, 18, and 24 months. Fasting LDL-C concentration was assessed at baseline and at 12 and 24 months. Health plan accounting records were used to assess medical service costs. Quality-adjusted life-years (QALYs) were assessed using a previously developed regression model based on intervention vs UC differences in HbA(1c), LDL-C, and SBP levels over 24 months.
  
  
  RESULTS
  Over 24 months, compared with UC controls, intervention patients had a mean of 114 (95% CI, 79 to 149) additional depression-free days and an estimated 0.335 (95% CI, -0.18 to 0.85) additional QALYs. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, -$3241 to $2053) relative to UC patients.
  
  
  CONCLUSIONS
  For adults with depression and poorly controlled diabetes, CHD, or both, a systematic intervention program aimed at improving depression scores and HbA(1c), SBP, and LDL-C levels seemed to be a high-value program that for no or modest additional cost markedly improved QALYs.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00468676
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. wkaton@uw.edu
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Julie
authors.initials: J
authors.lastname: Schmittdiel
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Do
authors.initials: D
authors.lastname: Peterson
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
mesh_terms: D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000032:analysis; D003327:Coronary Disease / Q000150:complications / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D048909:Diabetes Complications / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000191:economics*
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human