TY - JOUR KW - Age Factors KW - Aged KW - Cooperative Behavior KW - Cost-Benefit Analysis KW - Depression/drug therapy/economics/therapy KW - Female KW - Health Care Costs KW - Humans KW - Male KW - Middle Aged KW - Outcome Assessment (Health Care) KW - Patient Care Team KW - Physicians, Family KW - Primary Health Care/economics KW - Program Evaluation KW - Time Factors AU - J. Unutzer AU - W. J. Katon AU - M . Y. Fan AU - M. C. Schoenbaum AU - E. H. Lin AU - R. D. Della Penna AU - D. Powers A1 - AB - OBJECTIVE: To determine the long-term effects on total healthcare costs of the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) program for late-life depression compared with usual care. STUDY DESIGN: Randomized controlled trial with enrollment from July 1999 through August 2001. The IMPACT trial, conducted in primary care practices in 8 delivery organizations across the United States, enrolled 1801 depressed primary care patients 60 years or older. Data are from the 2 IMPACT sites for which 4-year cost data were available. Trial enrollment across these 2 health maintenance organizations was 551 patients. METHODS: Participants were randomly assigned to the IMPACT intervention (n = 279) or to usual primary care (n = 272). Intervention patients had access to a depression care manager who provided education, behavioral activation, support of antidepressant medication management prescribed by their regular primary care provider, and problem-solving treatment in primary care for up to 12 months. Care managers were supervised by a psychiatrist and a primary care provider. The main outcome measures were healthcare costs during 4 years. RESULTS: IMPACT participants had lower mean total healthcare costs ($29 422; 95% confidence interval, $26 479-$32 365) than usual care patients ($32 785; 95% confidence interval, $27 648-$37 921) during 4 years. Results of a bootstrap analysis suggested an 87% probability that the IMPACT program was associated with lower healthcare costs than usual care. CONCLUSION: Compared with usual primary care, the IMPACT program is associated with a high probability of lower total healthcare costs during a 4-year period. BT - The American Journal of Managed Care C5 - Financing & Sustainability; Key & Foundational CP - 2 CY - United States IS - 2 JF - The American Journal of Managed Care N2 - OBJECTIVE: To determine the long-term effects on total healthcare costs of the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) program for late-life depression compared with usual care. STUDY DESIGN: Randomized controlled trial with enrollment from July 1999 through August 2001. The IMPACT trial, conducted in primary care practices in 8 delivery organizations across the United States, enrolled 1801 depressed primary care patients 60 years or older. Data are from the 2 IMPACT sites for which 4-year cost data were available. Trial enrollment across these 2 health maintenance organizations was 551 patients. METHODS: Participants were randomly assigned to the IMPACT intervention (n = 279) or to usual primary care (n = 272). Intervention patients had access to a depression care manager who provided education, behavioral activation, support of antidepressant medication management prescribed by their regular primary care provider, and problem-solving treatment in primary care for up to 12 months. Care managers were supervised by a psychiatrist and a primary care provider. The main outcome measures were healthcare costs during 4 years. RESULTS: IMPACT participants had lower mean total healthcare costs ($29 422; 95% confidence interval, $26 479-$32 365) than usual care patients ($32 785; 95% confidence interval, $27 648-$37 921) during 4 years. Results of a bootstrap analysis suggested an 87% probability that the IMPACT program was associated with lower healthcare costs than usual care. CONCLUSION: Compared with usual primary care, the IMPACT program is associated with a high probability of lower total healthcare costs during a 4-year period. PP - United States PY - 2008 SN - 1936-2692; 1088-0224 SP - 95 EP - 100 EP - T1 - Long-term cost effects of collaborative care for late-life depression T2 - The American Journal of Managed Care TI - Long-term cost effects of collaborative care for late-life depression U1 - Financing & Sustainability; Key & Foundational U2 - 18269305 VL - 14 VO - 1936-2692; 1088-0224 Y1 - 2008 ER -