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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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.
