title: The Costs and Cost-effectiveness of Collaborative Care for Adolescents With Depression in Primary Care Settings: A Randomized Clinical Trial.
abstract: Depression is one of the most common adolescent chronic health conditions and can lead to increased health care use. Collaborative care models have been shown to be effective in improving adolescent depressive symptoms, but there are few data on the effect of such a model on costs.
  
  
  
  To evaluate the costs and cost-effectiveness of a collaborative care model for treatment of adolescent major depressive disorder in primary care settings.
  
  
  
  This randomized clinical trial was conducted between April 1, 2010, and April 30, 2013, at 9 primary care clinics in the Group Health system in Washington State. Participants were adolescents (age range, 13-17 years) with depression who participated in the Reaching Out to Adolescents in Distress (ROAD) collaborative care intervention trial.
  
  
  
  A 12-month collaborative care intervention included an initial in-person engagement session, delivery of evidence-based treatments, and regular follow-up by master's level clinicians. Youth in the usual care control condition received depression screening results and could access mental health services and obtain medications through Group Health.
  
  
  
  Cost outcomes included intervention costs and per capita health plan costs, calculated from the payer perspective using administrative records. The primary effectiveness outcome was the difference in quality-adjusted life-years (QALYs) between groups from baseline to 12 months. The QALYs were calculated using Child Depression Rating Scale-Revised scores measured during the clinical trial. Cost and QALYs were used to calculate an incremental cost-effectiveness ratio.
  
  
  
  Of those screened, 105 youths met criteria for entry into the study, and 101 were randomized to the intervention (n = 50) and usual care (n = 51) groups. Overall health plan costs were not significantly different between the intervention ($5161; 95% CI, $3564-$7070) and usual care ($5752; 95% CI, $3814-$7952) groups. Intervention delivery cost an additional $1475 (95% CI, $1230-$1695) per person. The intervention group had a mean daily utility value of 0.78 (95% CI, 0.75-0.80) vs 0.73 (95% CI, 0.71-0.76) for the usual care group. The net mean difference in effectiveness was 0.04 (95% CI, 0.02-0.09) QALY at $883 above usual care. The mean incremental cost-effectiveness ratio was $18 239 (95% CI, dominant to $24 408) per QALY gained, with dominant indicating that the intervention resulted in both a net cost savings and a net increase in QALYs.
  
  
  
  Collaborative care for adolescent depression appears to be cost-effective, with 95% CIs far below the strictest willingness-to-pay thresholds. These findings support the use of collaborative care interventions to treat depression among adolescent youth.
  
  
  
  clinicaltrials.gov Identifier: NCT01140464.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington.
authors.forename: Davene R
authors.initials: DR
authors.lastname: Wright
authors.affiliation: Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington.
authors.forename: Wren L
authors.initials: WL
authors.lastname: Haaland
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCauley
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lindenbaum
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington3Group Health Research Institute, Seattle, Washington4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D013997:Time Factors; D014861:Washington