Context
Major depressive disorders are frequently underdiagnosed and undertreated. Collaborative
Care models developed from the Chronic Care Model during the past 20 years have improved
the quality of depression management in the community, raising intervention cost incrementally
above usual care. This paper assesses the economic efficiency of collaborative care
for management of depressive disorders by comparing its economic costs and economic
benefits to usual care, as informed by a systematic review of the literature.
Evidence acquisition
The economic review of collaborative care for management of depressive disorders was
conducted in tandem with a review of effectiveness, under the guidance of the Community
Preventive Services Task Force, a nonfederal, independent group of public health leaders
and experts. Economic review methods developed by the Guide to Community Preventive Services were used by two economists to screen, abstract, adjust, and summarize the economic
evidence of collaborative care from societal and other perspectives. An earlier economic
review that included eight RCTs was included as part of the evidence. The present
economic review expanded the evidence with results from studies published from 1980
to 2009 and included both RCTs and other study designs.
Evidence synthesis
In addition to the eight RCTs included in the earlier review, 22 more studies of collaborative
care that provided estimates for economic outcomes were identified, 20 of which were
evaluations of actual interventions and two of which were based on models. Of seven
studies that measured only economic benefits of collaborative care in terms of averted
healthcare or productivity loss, four found positive economic benefits due to intervention
and three found minimal or no incremental benefit. Of five studies that measured both
benefits and costs, three found lower collaborative care cost because of reduced healthcare
utilization or enhanced productivity, and one found the same for a subpopulation of
the intervention group. One study found that willingness to pay for collaborative
care exceeded program costs. Among six cost–utility studies, five found collaborative
care was cost effective. In two modeled studies, one showed cost effectiveness based
on comparison of $/disability-adjusted life-year to annual per capita income; the
other demonstrated cost effectiveness based on the standard threshold of $50,000/quality-adjusted
life year, unadjusted for inflation. Finally, six of eight studies in the earlier
review reported that interventions were cost effective on the basis of the standard
threshold.
Conclusions
The evidence indicates that collaborative care for management of depressive disorders
provides good economic value.
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References
- The global burden of disease: 2004 update.WHO, Geneva2008
- The numbers count: mental disorders in America.
- The economic burden of depression.Gen Hosp Psychiatry. 1986; 8: 387-394
- The economic burden of depression in 1990.J Clin Psychiatry. 1993; 54: 405-418
- Depression in the workplace: an economic perspective.in: Feighner J.P. Boyer W.F. Selective serotonin re-uptake inhibitors: advances in basic research and clinical practice. John Wiley & Sons, New York1996: 327-363
- The economic burden of depression in the U.S.: how did it change between 1990 and 2000?.J Clin Psychiatry. 2003; 64: 1465-1475
- The health and productivity cost burden of the “top 10” physical and mental health conditions affecting six large U.S. employers in 1999.J Occup Environ Med. 2003; 45: 5-14
- The economic burden of depression in the U.S.: societal and patient perspectives.Expert Opin Pharmacother. 2005; 6: 369-376
- Prevalence and treatment of mental disorders, 1990 to 2003.N Engl J Med. 2005; 352: 2515-2523
- National trends in the outpatient treatment of depression.JAMA. 2002; 287: 203-209
- Twelve-month use of mental health services in the U.S.: results from the National Comorbidity Survey Replication.Arch Gen Psychiatry. 2005; 62: 629-640
- Identification and management of depression in primary care settings.Epidemiol Psichiatr Soc. 2006; 15: 276-283
- Long term outcome of primary care depression.J Affect Disord. 2009; 118: 79-86
- Prevalence, comorbidity, and service utilization for mood disorders in the U.S. at the beginning of the twenty-first century.Annu Rev Clin Psychol. 2007; 3: 137-158
- Depression care in the U.S.: too little for too few.Arch Gen Psychiatry. 2010; 67: 37-46
- Collaborative care to improve the management of depressive disorders: a Community Guide systematic review and meta-analysis.Am J Prev Med. 2012; 42: 525-538
- Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services.Am J Prev Med. 2000; 18: 75-91
- Developing an evidence-based Guide to Community Preventive Services—methods.Am J Prev Med. 2000; 18: 35-43
- Improving depression treatment in primary care: The Collaborative Care model.
- Cost-effectiveness in health and medicine.Oxford University Press, New York1996
- Consumer price index—all urban consumers.
- Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations.Br J Psychiatry. 2006; 189: 297-308
- Community-integrated home-based depression treatment in older adults: a randomized controlled trial.JAMA. 2004; 291: 1569-1577
- Randomized controlled trial of collaborative care management of depression among low-income patients with cancer.J Clin Oncol. 2008; 26: 4488-4496
- The influence of integration on the expenditures and costs of mental health and substance use care: results from the Randomized PRISM-E Study.Ageing Int. 2008; 32: 108-127
- Taking an evidence-based model of depression care from research to practice: making lemonade out of depression.Gen Hosp Psychiatry. 2006; 28: 101-107
- Cost-effectiveness of systematic depression treatment among people with diabetes mellitus.Arch Gen Psychiatry. 2007; 64: 65-72
- Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial.JAMA. 2007; 298: 1401-1411
- UPBEAT: the impact of a psychogeriatric intervention in VA medical centers.Med Care. 2001; 39: 500-512
- Can mental health integration in a primary care setting improve quality and lower costs?.J Manag Care Pharm. 2006; 12: 14-20
- Cost and quality impact of Intermountain's mental health integration program.J Healthc Manag. 2009; 55: 97-113
- RCT of a care manager intervention for major depression in primary care: 2-year costs for patients with physical vs psychological complaints.Ann Fam Med. 2005; 3: 15-22
- Modeling the impact of enhanced depression treatment on workplace functioning and costs: a cost-benefit approach.Med Care. 2006; 44: 352-358
- Long-term cost effects of collaborative care for late-life depression.Am J Manag Care. 2008; 14: 95-100
- A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: description of the model, patient characteristics and their use of medical resources.Fam Pract. 2002; 19: 251-256
- Cost-effectiveness of a primary care intervention for depressed females.J Affect Disord. 2003; 74: 23-32
- One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention.Psychol Med. 2005; 35: 839-854
- Cost-effectiveness of enhancing primary care depression management on an ongoing basis.Ann Fam Med. 2005; 3: 7-14
- Cost-effectiveness of interventions for depressed Latinos.J Ment Health Policy Econ. 2004; 7: 69-76
- Management of depression for people with cancer (SMaRT oncology 1): a randomised trial.Lancet. 2008; 372: 40-48
- Cost-effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder.Psychiatr Serv. 2007; 58: 1269-1278
- Willingness to pay for depression treatment in primary care.Psychiatr Serv. 2003; 54: 340-345
- Cost-effectiveness of treatments for major depression in primary care practice.Arch Gen Psychiatry. 1998; 55: 645-651
- Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions.Br J Psychiatry. 2004; 184: 393-403
- Macroeconomics and health: Investing in health for economic development: report of the Commission on Macroeconomics and Health.WHO, Geneva2001
- The costs and benefits of enhanced depression care to employers.Arch Gen Psychiatry. 2006; 63: 1345-1353
Article info
Footnotes
The names and affiliations of the Task Force members are available at www.thecommmunityguide.org/about/task-force-members.html.
Identification
Copyright
Published by Elsevier Inc.