2043. Cost-Effectiveness of Collaborative Care Depression Treatment in a Veteran Primary Care Population
CF Liu, Northwest Center for Health Services Research and Development, VA Puget Sound Health Care System, SC Hedrick, Northwest Center for Health Services Research and Development, EF Chaney, Northwest Center for Health Services Research and Development, P Heagerty, Department of Biostatistics, Univeristy of Washington, B Felker, VA Puget Sound Health Care System, N Hasenberg, Department of Health Services, University of Washington, SD Fihn, Northwest Center for Health Services Research and Development, W Katon, Department of Psychiatry, University of Washington

Objectives: Most depression treatment takes place in primary care, where it continues to be under-detected and under-treated. The collaborative care models for depression treatment have been demonstrated to improve patient outcomes. This study examined the incremental cost-effectiveness of a collaborative care intervention for depression compared to consult-liaison treatment of equal resource availability.

Methods: 354 primary care patients in a VA primary care clinic meeting the criteria for major depression and/or dysthymia were randomly assigned to care model by clinic firm. In collaborative care, a mental health team provided a treatment plan to primary care providers, telephoned patients to support adherence, reviewed treatment results, and suggested modifications. Outcomes were assessed at 3, 9 months by telephone interviews. Health care utilization and costs were assessed through the VA administrative databases and accounting system.

Results: Collaborative care resulted in significantly more patients treated for depression and prescribed antidepressants. Collaborative care patients experienced 14.6 additional depression-free days over 9 months (95%CI = -0.5 to 29.6, p=0.059). The mean incremental cost per patient of the intervention was $237 for depression treatment cost (95%CI = $70 to $404) and $519 for total outpatient cost (95%CI = $47 to $1003). The intervention program accounted for the majority of additional expenditures. The incremental cost-effectiveness ratio was $24 per depression-free day for depression treatment costs (95%CI = -$105 to $148) and $33 for total outpatient cost (95%CI = -$106 to $232).

Conclusions: Better coordination and communication under collaborative care resulted in more patients treated for depression, and moderate increases in days free of depression and treatment cost. These findings, consistent with recent non-VA studies, show that improving outcomes of depression treatment in primary care requires system reorganization.

Impact: Our findings demonstrate that even in a very difficult to treat population, systematically reorganizing the delivery of mental health services using a collaborative care model does treat more patients for depression in primary care with a modest incremental cost.