TY - JOUR
KW - Catchment Area (Health)
KW - Cooperative Behavior
KW - Cost-Benefit Analysis/statistics & numerical data
KW - Depressive Disorder/drug therapy/economics/therapy
KW - Female
KW - Health Care Costs/statistics & numerical data
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Care Team/economics
KW - Primary Health Care/economics/methods
KW - Quality-Adjusted Life Years
KW - Rural Health Services/economics/statistics & numerical data
KW - Telemedicine/economics/methods
KW - Treatment Outcome
KW - United States
KW - United States Department of Veterans Affairs/statistics & numerical data
AU - J. M. Pyne
AU - J. C. Fortney
AU - S. P. Tripathi
AU - M. L. Maciejewski
AU - M. J. Edlund
AU - D. K. Williams
A1 - 
AB - CONTEXT: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. OBJECTIVE: To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention. DESIGN: Randomized controlled trial of intervention vs usual care. SETTING: Seven small (serving 1000 to 5000 veterans) Veterans Health Administration community-based outpatient clinics serving rural catchment areas in 3 mid-South states. Each site had interactive televideo dedicated to mental health but no psychiatrist or psychologist on site. Patients Among 18 306 primary care patients who were screened, 1260 (6.9%) screened positive for depression; 395 met eligibility criteria and were enrolled from April 2003 to September 2004. Of those enrolled, 360 (91.1%) completed a 6-month follow-up and 335 (84.8%) completed a 12-month follow-up. Intervention A stepped-care model for depression treatment was used by an off-site depression care team to make treatment recommendations via electronic medical record. The team included a nurse depression care manager, clinical pharmacist, and psychiatrist. The depression care manager communicated with patients via telephone and was supported by computerized decision support software. MAIN OUTCOME MEASURES: The base case cost analysis included outpatient, pharmacy, and intervention expenditures. The effectiveness outcomes were depression-free days and quality-adjusted life years (QALYs) calculated using the 12-Item Short Form Health Survey standard gamble conversion formula. RESULTS: The incremental depression-free days outcome was not significant (P = .10); therefore, further cost-effectiveness analyses were not done. The incremental QALY outcome was significant (P = .04) and the mean base case incremental cost-effectiveness ratio was $85 634/QALY. Results adding inpatient costs were $111 999/QALY to $132 175/QALY. CONCLUSIONS: In rural settings, a telemedicine-based collaborative care intervention for depression is effective and expensive. The mean base case result was $85 634/QALY, which is greater than cost per QALY ratios reported for other, mostly urban, depression collaborative care interventions.
BT - Archives of General Psychiatry
C5 - Financing & Sustainability; HIT & Telehealth; Healthcare Policy
CP - 8
CY - United States
DO - 10.1001/archgenpsychiatry.2010.82
IS - 8
JF - Archives of General Psychiatry
N2 - CONTEXT: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. OBJECTIVE: To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention. DESIGN: Randomized controlled trial of intervention vs usual care. SETTING: Seven small (serving 1000 to 5000 veterans) Veterans Health Administration community-based outpatient clinics serving rural catchment areas in 3 mid-South states. Each site had interactive televideo dedicated to mental health but no psychiatrist or psychologist on site. Patients Among 18 306 primary care patients who were screened, 1260 (6.9%) screened positive for depression; 395 met eligibility criteria and were enrolled from April 2003 to September 2004. Of those enrolled, 360 (91.1%) completed a 6-month follow-up and 335 (84.8%) completed a 12-month follow-up. Intervention A stepped-care model for depression treatment was used by an off-site depression care team to make treatment recommendations via electronic medical record. The team included a nurse depression care manager, clinical pharmacist, and psychiatrist. The depression care manager communicated with patients via telephone and was supported by computerized decision support software. MAIN OUTCOME MEASURES: The base case cost analysis included outpatient, pharmacy, and intervention expenditures. The effectiveness outcomes were depression-free days and quality-adjusted life years (QALYs) calculated using the 12-Item Short Form Health Survey standard gamble conversion formula. RESULTS: The incremental depression-free days outcome was not significant (P = .10); therefore, further cost-effectiveness analyses were not done. The incremental QALY outcome was significant (P = .04) and the mean base case incremental cost-effectiveness ratio was $85 634/QALY. Results adding inpatient costs were $111 999/QALY to $132 175/QALY. CONCLUSIONS: In rural settings, a telemedicine-based collaborative care intervention for depression is effective and expensive. The mean base case result was $85 634/QALY, which is greater than cost per QALY ratios reported for other, mostly urban, depression collaborative care interventions.
PP - United States
PY - 2010
SN - 1538-3636; 0003-990X
SP - 812
EP - 821
EP - 
T1 - Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression
T2 - Archives of General Psychiatry
TI - Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression
U1 - Financing & Sustainability; HIT & Telehealth; Healthcare Policy
U2 - 20679589
U3 - 10.1001/archgenpsychiatry.2010.82
VL - 67
VO - 1538-3636; 0003-990X
Y1 - 2010
ER -