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
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
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.
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).
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.