1. Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness.
- Author
-
Celano, Christopher M., Healy, Brian, Suarez, Laura, Levy, Douglas E., Mastromauro, Carol, Januzzi, James L., and Huffman, Jeff C.
- Subjects
- *
ANXIETY treatment , *MENTAL depression , *THERAPEUTICS , *CARDIAC patients , *MEDICAL care costs , *QUALITY of life , *ANXIETY diagnosis , *DIAGNOSIS of mental depression , *HEART disease diagnosis , *HEART diseases , *HEALTH care teams , *ANXIETY , *COMPARATIVE studies , *COOPERATIVENESS , *COST control , *COST effectiveness , *HEALTH status indicators , *INTERPROFESSIONAL relations , *HOSPITAL emergency services , *RESEARCH methodology , *MEDICAL cooperation , *MEDICAL care use , *MENTAL health , *PROBABILITY theory , *RESEARCH , *TIME , *EVALUATION research , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *QUALITY-adjusted life years , *ACUTE diseases , *STATISTICAL models , *ECONOMICS , *PSYCHOLOGY - Abstract
Objective: To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization.Methods: The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs.Results: The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs.Conclusions: This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF