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The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
11231 Results
2621
Cost-effectiveness analysis of collaborative care management of major depression among low-income, predominantly Hispanics with diabetes
Type: Journal Article
Year: 2011
Abstract: Abstract. OBJECTIVE: To evaluate the cost-effectiveness of a socioculturally adapted collaborative depression care program among low-income Hispanics with diabetes. RESEARCH DESIGN AND METHODS: A randomized controlled trial of 387 patients with diabetes (96.5% Hispanic) with clinically significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program aimed at increasing patient exposure to evidence-based depression psychotherapy and/or pharmacotherapy in two public safety net clinics. Patient medical care costs and utilization were captured from Los Angeles County Department of Health Services claims records. Patient-reported outcomes included Short-Form Health Survey-12 and Patient Health Questionnaire-9-calculated depression-free days. RESULTS: Intervention patients had significantly greater Short-Form Health Survey-12 utility improvement from baseline compared with controls over the 18-month evaluation period (4.8%; P < 0.001) and a corresponding significant improvement in depression-free days (43.0; P < 0.001). Medical cost differences were not statistically significant in ordinary least squares and log-transformed cost regressions. The average costs of the Multifaceted Diabetes and Depression Program study intervention were $515 per patient. The program's cost-effectiveness averaged $4053 per quality-adjusted life-year per MDDP recipient and was more than 90% likely to fall below $12,000 per quality-adjusted life-year. CONCLUSIONS: Socioculturally adapted collaborative depression care improved utility and quality of life in predominantly low-income Hispanic patients with diabetes and was highly cost-effective.
Topic(s):
Financing & Sustainability
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2624
Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder
Type: Journal Article
Year: 2002
Publication Place: United States
Abstract: BACKGROUND: A collaborative care (CC) intervention for patients with panic disorder that provided increased patient education and integrated a psychiatrist into primary care was associated with improved symptomatic and functional outcomes. This report evaluates the incremental cost-effectiveness and potential cost offset of a CC treatment program for primary care patients with panic disorder from the perspective of the payer. METHODS: We randomly assigned 115 primary care patients with panic disorder to a CC intervention that included systematic patient education and approximately 2 visits with an on-site consulting psychiatrist, compared with usual primary care. Telephone assessments of clinical outcomes were performed at 3, 6, 9, and 12 months. Use of health care services and costs were assessed using administrative data from the primary care clinics and self-report data. RESULTS: Patients receiving CC experienced a mean of 74.2 more anxiety-free days during the 12-month intervention (95% confidence interval [CI], 15.8-122.0). The incremental mental health cost of the CC intervention was $205 (95% CI, -$135 to $501), with the additional mental health costs of the intervention explained by expenditures for antidepressant medication and outpatient mental health visits. Total outpatient cost was $325 (95% CI, -$1460 to $448) less for the CC than for the usual care group. The incremental cost-effectiveness ratio for total ambulatory cost was -$4 (95% CI, -$23 to $14) per anxiety-free day. Results of a bootstrap analysis suggested a 0.70 probability that the CC intervention was dominant (eg, lower costs and greater effectiveness). CONCLUSION: A CC intervention for patients with panic disorder was associated with significantly more anxiety-free days, no significant differences in total outpatient costs, and a distribution of the cost-effectiveness ratio based on total outpatient costs that suggests a 70% probability that the intervention was dominant, compared with usual care.
Topic(s):
Financing & Sustainability
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View the DOI record for Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder
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View the PubMed citation for Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder2625
Cost-Effectiveness Evaluation of Collaborative Care for Diabetes and Depression in Primary Care
Type: Journal Article
Year: 2016
Publication Place: Netherlands
Topic(s):
Education & Workforce
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, Financing & Sustainability
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Reference Links:
View the DOI record for Cost-Effectiveness Evaluation of Collaborative Care for Diabetes and Depression in Primary Care
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View the PubMed citation for Cost-Effectiveness Evaluation of Collaborative Care for Diabetes and Depression in Primary Care2626
Cost-effectiveness implications of increasing the efficiency of the extended-release naltrexone induction process for the treatment of opioid use disorder: a secondary analysis
Type: Journal Article
Year: 2021
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Opioids & Substance Use
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2628
Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study
Type: Journal Article
Year: 2018
Publication Place: England
Topic(s):
Financing & Sustainability
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2629
Cost-effectiveness of a collaborative care program for managing major depression and chronic musculoskeletal pain in primary care: Economic evaluation alongside a randomized controlled trial
Type: Journal Article
Year: 2020
Publication Place: England
Topic(s):
Financing & Sustainability
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, Healthcare Disparities
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2630
Cost-effectiveness of a collaborative care program for primary care patients with persistent depression
Type: Journal Article
Year: 2001
Publication Place: United States
Abstract: 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.
Topic(s):
Financing & Sustainability
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, Key & Foundational
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Reference Links: View the PubMed citation for Cost-effectiveness of a collaborative care program for primary care patients with persistent depression
2631
Cost-effectiveness of a disease management program for major depression in elderly primary care patients
Type: Journal Article
Year: 2006
Publication Place: United States
Abstract: BACKGROUND: Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. OBJECTIVE: To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care. DESIGN: Economic evaluation alongside a cluster randomized-controlled trial. PARTICIPANTS: Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis. INTERVENTIONS: General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way. MEASUREMENTS: Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs. RESULTS: Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups. CONCLUSIONS: This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.
Topic(s):
Financing & Sustainability
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Reference Links:
View the DOI record for Cost-effectiveness of a disease management program for major depression in elderly primary care patients
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View the PubMed citation for Cost-effectiveness of a disease management program for major depression in elderly primary care patients2632
Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: Results of an economic evaluation alongside a pragmatic randomised control trial
Type: Journal Article
Year: 2010
Publication Place: Netherlands
Abstract: BACKGROUND: Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC). METHODS: We conducted an economic evaluation from a societal perspective. Quality-adjusted life years (QALYs) and resource use were measured by the EuroQol and cost diaries, respectively. Uncertainty was estimated by 95% confidence intervals, cost-effectiveness planes and acceptability curves. Sensitivity analyses and ancillary analyses based on preplanned subgroups were performed. RESULTS: No statistically significant differences in costs or QALYs were observed. The mean incremental cost per QALY was -euro 7356 and located in the southeast quadrant of the cost-effectiveness plane, whereby the intervention was slightly more effective and less costly. For willingness-to-pay (lambda) thresholds from euro 0 to euro 100,000, the probability of MISS being cost-effective was 0.58-0.90. For the preplanned subgroup of patients diagnosed with stress-related mental disorders, the incremental ratio was -euro 28,278, again in the southeast quadrant. Corresponding probabilities were 0.92 or greater. LIMITATIONS: Non-significant findings may be related to poor implementation of the MISS intervention and low power. Also, work-presenteeism and unpaid labor were not measured. CONCLUSIONS: The minimal intervention was not cost-effective compared to usual care for a heterogeneous patient population. Therefore, we do not recommend widespread implementation. However, the intervention may be cost-effective for the subgroup stress-related mental disorders. This finding should be confirmed before implementation for this subgroup is considered.
Topic(s):
Financing & Sustainability
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2633
Cost-effectiveness of a primary care depression intervention
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: OBJECTIVE: To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN: Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING: Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS: Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS: Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS: Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was US dollars 15463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from US dollars 11341 (using geographic block variables to control for pre-intervention service utilization) to US dollars 19976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS: This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for Cost-effectiveness of a primary care depression intervention
2634
Cost-effectiveness of a primary care model for anxiety disorders
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: BACKGROUND: Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care. AIMS: To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care. METHOD: In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up. RESULTS: No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ-5D during follow-up. Total costs were higher in the intervention group (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio
Topic(s):
Financing & Sustainability
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Reference Links:
View the DOI record for Cost-effectiveness of a primary care model for anxiety disorders
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View the PubMed citation for Cost-effectiveness of a primary care model for anxiety disorders2635
Cost-effectiveness of a program to prevent depression relapse in primary care
Type: Journal Article
Year: 2002
Publication Place: United States
Abstract: OBJECTIVE: Evaluate the incremental cost-effectiveness of a depression relapse prevention program in primary care. MATERIALS AND METHODS: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks later. Those recovered from the current episode but at high risk for relapse (based on history of recurrent depression or dysthymia) were offered randomization to usual care or a relapse prevention intervention. The intervention included systematic patient education, two psychoeducational visits with a depression prevention specialist, shared decision-making regarding maintenance pharmacotherapy, and telephone and mail monitoring of medication adherence and depressive symptoms. Outcomes in both groups were assessed via blinded telephone assessments at 3, 6, 9, and 12 months and health plan claims and accounting data. RESULTS: Intervention patients experienced 13.9 additional depression-free days during a 12-month period (95% CI, -1.5 to 29.3). Incremental costs of the intervention were $273 (95% CI, $102 to $418) for depression treatment costs only and $160 (95% CI, -$173 to $512) for total outpatient costs. Incremental cost-effectiveness ratio was $24 per depression-free day (95% CI, -$59 to $496) for depression treatment costs only and $14 per depression-free day (95% CI, -$35 to $248) for total outpatient costs. CONCLUSIONS: A program to prevent depression relapse in primary care yields modest increases in days free of depression and modest increases in treatment costs. These modest differences reflect high rates of treatment in usual care. Along with other recent studies, these findings suggest that improved care of depression in primary care is a prudent investment of health care resources.
Topic(s):
Financing & Sustainability
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Reference Links:
View the DOI record for Cost-effectiveness of a program to prevent depression relapse in primary care
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View the PubMed citation for Cost-effectiveness of a program to prevent depression relapse in primary care2636
Cost-effectiveness of a psychoeducational relapse prevention program for depression in primary care
Type: Journal Article
Year: 2009
Publication Place: Italy
Abstract: BACKGROUND: Major depression is a prevalent mental disorder with a high risk of relapses and recurrences, which are associated with considerable burden for patients and high costs for society. Despite these negative consequences, only few studies have focused on interventions aimed at the prevention of recurrences in primary care patients with depression. AIMS OF THE STUDY: To assess the cost-effectiveness of a psychoeducational prevention program (PEP) aimed at improving the long-term outcome of depression in primary care. METHODS: Recruitment took place in the northern part of the Netherlands, patients were referred by general practitioners. In total 267 patients were included in the study and randomly assigned to usual care (UC) or UC with one of three forms of PEP; PEP alone, psychiatric consultation followed by PEP (psychiatrist-enhanced PEP), and cognitive behavioral therapy followed by PEP (CBT-enhanced PEP). Costs and health outcomes were registered at three month intervals during the 36 months follow-up of the study. Primary outcome measure was the proportion of depression-free time. RESULTS: Mean total costs during the 36 months of the study were 8200 euros in the UC group, 9816 euros in the PEP group, 9844 euros in the psychiatrist-enhanced PEP group, and 9254 euros in the CBT-enhanced PEP group. Costs of productivity losses, hospital admissions, contacts with regional institutions for mental healthcare, and medication use contributed substantially to the total costs in each group. Results of the primary outcome measure were less positive for PEP than for UC, but slightly better in the enhanced PEP groups. If decision-makers are willing to pay up to 300 euros for an additional proportion of depression-free time, UC is most likely to be the optimal intervention. For higher willingness to pay, CBT-enhanced PEP seems most efficient. DISCUSSION: The basic PEP intervention was not cost-effective in comparison with UC. The economic impact of productivity losses associated with depression, and the importance of including these costs in economic studies, was illustrated by the findings of this study. Due to the drop-out of patients during the 36 months follow-up period, economic analyses had to account for missing data, which may complicate the interpretation of the results. Although Quality-Adjusted Life Years (QALYs) could not be assessed for all the patients, the results of analyses focusing on QALYs supported the overall conclusion that PEP is not cost-effective. IMPLICATIONS FOR HEALTH CARE PROVISION AND POLICIES: Results indicated that PEP should not be implemented in the Dutch healthcare system. Furthermore, is seems highly unlikely that PEP could be cost-effective in other (comparable) European healthcare systems. IMPLICATIONS FOR FURTHER RESEARCH: The relatively positive economic results for CBT-enhanced PEP imply that UC enriched with CBT (but without PEP) might be cost-effective in preventing relapses in primary care patients with depression. The actual consequences of CBT for relapse prevention will have to be studied in further detail, both from a clinical and economic point of view.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for Cost-effectiveness of a psychoeducational relapse prevention program for depression in primary care
2637
Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: Randomised trial
Type: Journal Article
Year: 2010
Publication Place: England
Abstract: BACKGROUND: There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders. AIMS: To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care. METHOD: An economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84). RESULTS: The intervention was successful in halving the incidence rate of depression and anxiety at euro563 ( pound412) per recipient and euro4367 ( pound3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least euro5000. CONCLUSIONS: The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.
Topic(s):
Financing & Sustainability
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Reference Links:
View the DOI record for Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: Randomised trial
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View the PubMed citation for Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: Randomised trial