TY - JOUR
KW - Age Factors
KW - Aged
KW - Ambulatory Care/economics
KW - Cost-Benefit Analysis
KW - Delivery of Health Care/economics/methods
KW - Depressive Disorder, Major/economics/therapy
KW - Female
KW - Health Care Costs/statistics & numerical data
KW - Hospitalization/economics
KW - Humans
KW - Male
KW - Managed Care Programs/economics
KW - Middle Aged
KW - Outcome Assessment (Health Care)
KW - Primary Health Care/economics
KW - Quality of Life
KW - Treatment Outcome
AU - W. J. Katon
AU - M. Schoenbaum
AU - M . Y. Fan
AU - C. M. Callahan
AU - J. Williams
AU - E. Hunkeler
AU - L. Harpole
AU - X. H. Zhou
AU - C. Langston
AU - J. Unutzer
A1 - 
AB - CONTEXT: Depression is a leading cause of functional impairment in elderly individuals and is associated with high medical costs, but there are large gaps in quality of treatment in primary care. OBJECTIVE: To determine the incremental cost-effectiveness of the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. DESIGN: Randomized controlled trial with recruitment from July 1999 to August 2001. SETTING: Eighteen primary care clinics from 8 health care organizations in 5 states. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). INTERVENTION: Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual primary care (n = 895). Intervention patients were provided access to a depression care manager supervised by a psychiatrist and primary care physician. Depression care managers offered education, support of antidepressant medications prescribed in primary care, and problem-solving treatment in primary care (a brief psychotherapy). MAIN OUTCOME MEASURES: Total outpatient costs, depression-free days, and quality-adjusted life-years. RESULTS: Relative to usual care, intervention patients experienced 107 (95% confidence interval [CI], 86 to 128) more depression-free days over 24 months. Total outpatient costs were USD $295 (95% CI, -$525 to $1115) higher during this period. The incremental outpatient cost per depression-free day was USD $2.76 (95% CI, -$4.95 to $10.47) and incremental outpatient costs per quality-adjusted life-year ranged from USD $2519 (95% CI, -$4517 to $9554) to USD $5037 (95% CI, -$9034 to $19 108). Results of a bootstrap analysis suggested a 25% probability that the IMPACT intervention was "dominant" (ie, lower costs and greater effectiveness). CONCLUSIONS: The IMPACT intervention is a high-value investment for older adults; it is associated with high clinical benefits at a low increment in health care costs.
BT - Archives of General Psychiatry
C5 - Financing & Sustainability
CP - 12
CY - United States
DO - 10.1001/archpsyc.62.12.1313
IS - 12
JF - Archives of General Psychiatry
N2 - CONTEXT: Depression is a leading cause of functional impairment in elderly individuals and is associated with high medical costs, but there are large gaps in quality of treatment in primary care. OBJECTIVE: To determine the incremental cost-effectiveness of the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. DESIGN: Randomized controlled trial with recruitment from July 1999 to August 2001. SETTING: Eighteen primary care clinics from 8 health care organizations in 5 states. PARTICIPANTS: A total of 1801 patients 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). INTERVENTION: Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual primary care (n = 895). Intervention patients were provided access to a depression care manager supervised by a psychiatrist and primary care physician. Depression care managers offered education, support of antidepressant medications prescribed in primary care, and problem-solving treatment in primary care (a brief psychotherapy). MAIN OUTCOME MEASURES: Total outpatient costs, depression-free days, and quality-adjusted life-years. RESULTS: Relative to usual care, intervention patients experienced 107 (95% confidence interval [CI], 86 to 128) more depression-free days over 24 months. Total outpatient costs were USD $295 (95% CI, -$525 to $1115) higher during this period. The incremental outpatient cost per depression-free day was USD $2.76 (95% CI, -$4.95 to $10.47) and incremental outpatient costs per quality-adjusted life-year ranged from USD $2519 (95% CI, -$4517 to $9554) to USD $5037 (95% CI, -$9034 to $19 108). Results of a bootstrap analysis suggested a 25% probability that the IMPACT intervention was "dominant" (ie, lower costs and greater effectiveness). CONCLUSIONS: The IMPACT intervention is a high-value investment for older adults; it is associated with high clinical benefits at a low increment in health care costs.
PP - United States
PY - 2005
SN - 0003-990X; 0003-990X
SP - 1313
EP - 1320
EP - 
T1 - Cost-effectiveness of improving primary care treatment of late-life depression
T2 - Archives of General Psychiatry
TI - Cost-effectiveness of improving primary care treatment of late-life depression
U1 - Financing & Sustainability
U2 - 16330719
U3 - 10.1001/archpsyc.62.12.1313
VL - 62
VO - 0003-990X; 0003-990X
Y1 - 2005
ER -