title: Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness.
abstract: OBJECTIVE
  To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization.
  
  
  METHODS
  The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs.
  
  
  RESULTS
  The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs.
  
  
  CONCLUSIONS
  This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge.
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. Electronic address: ccelano@partners.org.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.affiliation: Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Healy
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Suarez
authors.affiliation: Harvard Medical School, Boston, MA, USA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Levy
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Mastromauro
authors.affiliation: Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D000208:Acute Disease; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D003299:Cooperative Behavior; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003863:Depression / Q000175:diagnosis / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006304:Health Status; D006331:Heart Diseases / Q000175:diagnosis / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D016013:Likelihood Functions; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D018803:Models, Economic; D010348:Patient Care Team / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome
keywords: anxiety; cardiovascular disease; collaborative care; cost-effectiveness; depression