title: Cost-Effectiveness of Collaborative Care for Depression in HIV Clinics.
abstract: OBJECTIVE
  To examine the cost-effectiveness of the HIV Translating Initiatives for Depression Into Effective Solutions (HITIDES) intervention.
  
  
  METHODS
  Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care.
  
  
  METHODS
  Three Veterans Health Administration HIV clinics in the Southern United States.
  
  
  METHODS
  Two hundred forty-nine HIV-infected patients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care.
  
  
  METHODS
  HITIDES consisted of an offsite HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment, and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines.
  
  
  METHODS
  Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost-effectiveness ratios (ICERs) and net health benefit. ICER distributions were generated using nonparametric bootstrap with replacement sampling.
  
  
  RESULTS
  The HITIDES intervention was more effective and cost saving compared with usual care in 78% of bootstrapped samples. The intervention net health benefit was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY.
  
  
  CONCLUSIONS
  In HIV clinic settings, this intervention was more effective and cost saving compared with usual care. Implementation of offsite depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients but also maximizes the efficient use of limited health care resources.
authors.affiliation: *Center for Mental Healthcare and Outcomes Research Central Arkansas Veterans Healthcare System North Little Rock, AR; †Division of Pharmaceutical Evaluation and Policy University of Arkansas for Medical Sciences Little Rock, AR; ‡South Central Mental Illness Research, Education and Clinical Centers Central Arkansas Veterans Healthcare System North Little Rock, AR; §Psychiatric Research Institute University of Arkansas for Medical Sciences Little Rock, AR; ‖VA New England Healthcare System Center for Healthcare Quality, Outcomes, and Economic Research Bedford, MA; ¶Atlanta VA Medical Center & Department of Infectious Disease Emory University, School of Medicine Atlanta, GA; #Department of Infectious Disease Central Arkansas Veterans Healthcare System North Little Rock, AR; and **Michael E. DeBakey VA Medical Center & Department of Medicine - Infectious Disease Baylor College of Medicine Houston, TX.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Painter
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Thomas
authors.initials: T
authors.lastname: Monson
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics* / Q000379:methods*; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003863:Depression / Q000188:drug therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States