TY - JOUR
KW - Adult
KW - Antidepressive Agents/economics/therapeutic use
KW - Cognitive Therapy/economics/methods
KW - Cost-Benefit Analysis
KW - Depressive Disorder/drug therapy/economics/therapy
KW - Female
KW - Health Care Costs
KW - Humans
KW - Interviews as Topic
KW - Male
KW - Middle Aged
KW - Patient Care Management/economics/methods
KW - Primary Health Care/economics/methods
KW - Telemedicine/economics/methods
KW - Treatment Outcome
AU - G. E. Simon
AU - E. J. Ludman
AU - C. M. Rutter
A1 - 
AB - CONTEXT: Effectiveness of organized depression care programs is well established, but dissemination will depend on the balance of benefits and costs. OBJECTIVES: To estimate the incremental benefit, incremental cost, and net benefit of 2 depression care programs. DESIGN: Randomized trial comparing 2 interventions with continued usual care, conducted between November 2000 and June 2004. SETTING: Seven primary care clinics of a prepaid health care plan in Washington. PARTICIPANTS: Consecutive primary care patients starting antidepressant treatment were invited to a telephone assessment 2 weeks later. Of 634 patients with significant depressive symptoms, 600 consented and were randomized. INTERVENTIONS: The telephone care management intervention included up to 5 outreach calls for monitoring and support, feedback to treating physicians, and care coordination. The care management plus telephone psychotherapy intervention added an 8-session structured cognitive behavioral therapy program with up to 4 additional calls for reinforcement. MAIN OUTCOME MEASURES: Independent, blinded telephone assessments at 1, 3, 6, 9, 12, and 18 months included the Symptom Checklist 90 depression scale. Health services costs were measured using health care plan accounting records. RESULTS: Over 24 months, telephone care management led to a gain of 29 depression-free days (95% confidence interval, -6 to +63) and a $676 increase in outpatient health care costs (95% confidence interval, $596 lower to $1974 higher). The incremental net benefit was negative even if a day free of depression was valued up to $20. Care management plus psychotherapy led to a gain of 46 depression-free days (95% confidence interval, +12 to +80) and a $397 increase in outpatient costs (95% confidence interval, $882 lower to $1725 higher). The incremental net benefit was positive if a day free of depression was valued at $9 or greater. CONCLUSION: Compared with current primary care practice, a structured telephone program including care management and cognitive behavioral psychotherapy has significant clinical benefit with only a modest increase in health services cost.
BT - Archives of General Psychiatry
C5 - Financing & Sustainability
CP - 10
CY - United States
DO - 10.1001/archgenpsychiatry.2009.123
IS - 10
JF - Archives of General Psychiatry
N2 - CONTEXT: Effectiveness of organized depression care programs is well established, but dissemination will depend on the balance of benefits and costs. OBJECTIVES: To estimate the incremental benefit, incremental cost, and net benefit of 2 depression care programs. DESIGN: Randomized trial comparing 2 interventions with continued usual care, conducted between November 2000 and June 2004. SETTING: Seven primary care clinics of a prepaid health care plan in Washington. PARTICIPANTS: Consecutive primary care patients starting antidepressant treatment were invited to a telephone assessment 2 weeks later. Of 634 patients with significant depressive symptoms, 600 consented and were randomized. INTERVENTIONS: The telephone care management intervention included up to 5 outreach calls for monitoring and support, feedback to treating physicians, and care coordination. The care management plus telephone psychotherapy intervention added an 8-session structured cognitive behavioral therapy program with up to 4 additional calls for reinforcement. MAIN OUTCOME MEASURES: Independent, blinded telephone assessments at 1, 3, 6, 9, 12, and 18 months included the Symptom Checklist 90 depression scale. Health services costs were measured using health care plan accounting records. RESULTS: Over 24 months, telephone care management led to a gain of 29 depression-free days (95% confidence interval, -6 to +63) and a $676 increase in outpatient health care costs (95% confidence interval, $596 lower to $1974 higher). The incremental net benefit was negative even if a day free of depression was valued up to $20. Care management plus psychotherapy led to a gain of 46 depression-free days (95% confidence interval, +12 to +80) and a $397 increase in outpatient costs (95% confidence interval, $882 lower to $1725 higher). The incremental net benefit was positive if a day free of depression was valued at $9 or greater. CONCLUSION: Compared with current primary care practice, a structured telephone program including care management and cognitive behavioral psychotherapy has significant clinical benefit with only a modest increase in health services cost.
PP - United States
PY - 2009
SN - 1538-3636; 0003-990X
SP - 1081
EP - 1089
EP - 
T1 - Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care
T2 - Archives of General Psychiatry
TI - Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care
U1 - Financing & Sustainability
U2 - 19805698
U3 - 10.1001/archgenpsychiatry.2009.123
VL - 66
VO - 1538-3636; 0003-990X
Y1 - 2009
ER -