TY - JOUR
KW - Adult
KW - Ambulatory Care/economics/utilization
KW - Antidepressive Agents/therapeutic use
KW - Continuity of Patient Care/economics/organization & administration
KW - Cost-Benefit Analysis
KW - Depressive Disorder/drug therapy/economics/therapy
KW - Female
KW - Follow-Up Studies
KW - Health Care Costs/statistics & numerical data
KW - Health Maintenance Organizations/economics/organization & administration
KW - Health Services/economics/utilization
KW - Humans
KW - Male
KW - Managed Care Programs/economics/organization & administration
KW - Patient Care Team
KW - Patient Compliance
KW - Patient Education as Topic
KW - Primary Health Care/economics/methods
KW - Psychiatry/economics/methods
KW - Referral and Consultation
KW - Treatment Outcome
AU - G. E. Simon
AU - W. J. Katon
AU - M. Von Korff
AU - J. Unutzer
AU - E. H. Lin
AU - E. A. Walker
AU - T. Bush
AU - C. Rutter
AU - E. Ludman
A1 - 
AB - OBJECTIVE: The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management. METHOD: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks after the initial prescription. Those with persistent major depression or significant subthreshold depressive symptoms were randomly assigned to continued usual care or collaborative care. The collaborative care included systematic patient education, an initial visit with a consulting psychiatrist, 2-4 months of shared care by the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Clinical outcomes were assessed through blinded telephone assessments at 1, 3, and 6 months. Health services utilization and costs were assessed through health plan claims and accounting data. RESULTS: Patients receiving collaborative care experienced a mean of 16.7 additional depression-free days over 6 months. The mean incremental cost of depression treatment in this program was $357. The additional cost was attributable to greater expenditures for antidepressant prescriptions and outpatient visits. No offsetting decrease in use of other health services was observed. The incremental cost-effectiveness was $21.44 per depression-free day. CONCLUSIONS: A stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs. These findings are consistent with those of other randomized trials. Improving outcomes of depression treatment in primary care requires investment of additional resources, but the return on this investment is comparable to that of many other widely accepted medical interventions.
BT - The American Journal of Psychiatry
C5 - Financing & Sustainability; Key & Foundational
CP - 10
CY - United States
IS - 10
JF - The American Journal of Psychiatry
N2 - OBJECTIVE: The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management. METHOD: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks after the initial prescription. Those with persistent major depression or significant subthreshold depressive symptoms were randomly assigned to continued usual care or collaborative care. The collaborative care included systematic patient education, an initial visit with a consulting psychiatrist, 2-4 months of shared care by the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Clinical outcomes were assessed through blinded telephone assessments at 1, 3, and 6 months. Health services utilization and costs were assessed through health plan claims and accounting data. RESULTS: Patients receiving collaborative care experienced a mean of 16.7 additional depression-free days over 6 months. The mean incremental cost of depression treatment in this program was $357. The additional cost was attributable to greater expenditures for antidepressant prescriptions and outpatient visits. No offsetting decrease in use of other health services was observed. The incremental cost-effectiveness was $21.44 per depression-free day. CONCLUSIONS: A stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs. These findings are consistent with those of other randomized trials. Improving outcomes of depression treatment in primary care requires investment of additional resources, but the return on this investment is comparable to that of many other widely accepted medical interventions.
PP - United States
PY - 2001
SN - 0002-953X; 0002-953X
SP - 1638
EP - 1644
EP - 
T1 - Cost-effectiveness of a collaborative care program for primary care patients with persistent depression
T2 - The American Journal of Psychiatry
TI - Cost-effectiveness of a collaborative care program for primary care patients with persistent depression
U1 - Financing & Sustainability; Key & Foundational
U2 - 11578996
VL - 158
VO - 0002-953X; 0002-953X
Y1 - 2001
ER -