TY - JOUR
AU - D. Xuan
AU - J. Burton
AU - L. Shi
AU - E. G. Price-Haywood
A1 - 
AB - OBJECTIVE: To conduct a cost-effectiveness analysis comparing behavioral health integration (BHI) in primary care vs clinical decision support (usual care) for adult patients with depression and/or anxiety taking chronic opioid therapy for noncancer pain. STUDY DESIGN: Piggyback economic analysis of data collected for 632 adult patients during a pragmatic, stepped-wedge, type 2 effectiveness-implementation hybrid trial conducted in a health system in Louisiana between April 2019 and June 2022. METHODS: The study used decision tree analysis. The base case modeled study patients and assessed costs associated with interventions, acute care, ambulatory utilization, and prescriptions. Efficacy measures were modeled using quality-adjusted life-years (QALYs) and morphine equivalent daily dose (MEDD). Sensitivity analyses included 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA). A US-based willingness to pay threshold range of $100,000 to $150,000 per QALY was used. RESULTS: In the base case, the BHI group incurred a cost of $10,489.19 per patient for 1 year compared with $5673.96 for usual care. BHI was associated with 0.0439 QALYs gained, which yielded an incremental cost-effectiveness ratio (ICER) of $108,784 per QALY. The BHI group had a MEDD reduction of 7.3 mg/d compared with an increase of 2.0 mg/d among usual care. This translates into an ICER of $513.51 per 1-mg/d reduction. One-way sensitivity analysis and PSA indicated that the cost of prescriptions for both study groups as well as the cost of primary care providers and licensed clinical social workers for the BHI group were the biggest drivers of cost-effectiveness. CONCLUSIONS: BHI was cost-effective from the health system perspective, with reductions in prescription drug expenses being the primary driver of savings.
AD - Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine, New Orleans, LA.; Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA.; University of Queensland Ochsner Clinical School, New Orleans, LA.; Ochsner-Xavier Institute for Health Equity and Research, New Orleans, LA.; Ochsner Health, 1401A Jefferson Hwy, Academic Center-2nd Floor, New Orleans, LA 70121. Email: eboni.pricehaywood@ochsner.org.
AN - 41838978
BT - Am J Manag Care
C5 - Financing & Sustainability
DA - Mar 13
DO - 10.37765/ajmc.2026.89913
DP - NLM
ET - 20260313
JF - Am J Manag Care
LA - eng
N2 - OBJECTIVE: To conduct a cost-effectiveness analysis comparing behavioral health integration (BHI) in primary care vs clinical decision support (usual care) for adult patients with depression and/or anxiety taking chronic opioid therapy for noncancer pain. STUDY DESIGN: Piggyback economic analysis of data collected for 632 adult patients during a pragmatic, stepped-wedge, type 2 effectiveness-implementation hybrid trial conducted in a health system in Louisiana between April 2019 and June 2022. METHODS: The study used decision tree analysis. The base case modeled study patients and assessed costs associated with interventions, acute care, ambulatory utilization, and prescriptions. Efficacy measures were modeled using quality-adjusted life-years (QALYs) and morphine equivalent daily dose (MEDD). Sensitivity analyses included 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA). A US-based willingness to pay threshold range of $100,000 to $150,000 per QALY was used. RESULTS: In the base case, the BHI group incurred a cost of $10,489.19 per patient for 1 year compared with $5673.96 for usual care. BHI was associated with 0.0439 QALYs gained, which yielded an incremental cost-effectiveness ratio (ICER) of $108,784 per QALY. The BHI group had a MEDD reduction of 7.3 mg/d compared with an increase of 2.0 mg/d among usual care. This translates into an ICER of $513.51 per 1-mg/d reduction. One-way sensitivity analysis and PSA indicated that the cost of prescriptions for both study groups as well as the cost of primary care providers and licensed clinical social workers for the BHI group were the biggest drivers of cost-effectiveness. CONCLUSIONS: BHI was cost-effective from the health system perspective, with reductions in prescription drug expenses being the primary driver of savings.
PY - 2026
SN - 1088-0224 (Print); 1088-0224
ST - Cost-effectiveness of integrated behavioral health for depression, anxiety, and chronic pain
T1 - Cost-effectiveness of integrated behavioral health for depression, anxiety, and chronic pain
T2 - Am J Manag Care
TI - Cost-effectiveness of integrated behavioral health for depression, anxiety, and chronic pain
U1 - Financing & Sustainability
U3 - 10.37765/ajmc.2026.89913
VO - 1088-0224 (Print); 1088-0224
Y1 - 2026
ER -