title: Twelve-month cost-effectiveness of telephone-delivered collaborative care for treating depression following CABG surgery: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians' usual care (UC).
  
  
  METHODS
  We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone 2 weeks following hospitalization (nine-item Patient Health Questionnaire ≥10) and were randomized to either an 8-month centralized, nurse-provided and telephone-delivered CC intervention for depression or to their physicians' UC.
  
  
  RESULTS
  At 12 months following randomization, CC patients had $2068 lower but statistically similar estimated median costs compared to UC (P=.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost-effectiveness ratio of CC was -$9889 (-$11,940 to -$7838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane also demonstrated a 68% probability of CC "dominating" UC (more QALYs at lower cost).
  
  
  CONCLUSIONS
  Centralized, nurse-provided and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care.
authors: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors: Julie M
authors: JM
authors: Donohue
authors: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Bea Herbeck
authors: BH
authors: Belnap
authors: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors: Aiju
authors: A
authors: Men
authors: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Fanyin
authors: F
authors: He
authors: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Mark S
authors: MS
authors: Roberts
authors: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA.
authors: Herbert C
authors: HC
authors: Schulberg
authors: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Charles F
authors: CF
authors: Reynolds
authors: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: rollmanbl@upmc.edu.
authors: Bruce L
authors: BL
authors: Rollman
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000523:psychology*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Cost–benefit analysis; Depression; Mental health services; Randomized controlled trial