Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness.
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.
['Celano|Christopher M|CM|', 'Healy|Brian|B|', 'Suarez|Laura|L|', 'Levy|Douglas E|DE|', 'Mastromauro|Carol|C|', 'Januzzi|James L|JL|', 'Huffman|Jeff C|JC|']
D000208:Acute Disease D000368:Aged D001007:Anxiety D003299:Cooperative Behavior D017046:Cost Savings D003362:Cost-Benefit Analysis D003863:Depression D004636:Emergency Service, Hospital D005260:Female D017048:Health Care Costs D006295:Health Resources D006304:Health Status D006331:Heart Diseases D006801:Humans D033183:Interdisciplinary Communication D016013:Likelihood Functions D008297:Male D008603:Mental Health D008875:Middle Aged D018803:Models, Economic D010348:Patient Care Team D011788:Quality of Life D019057:Quality-Adjusted Life Years D013997:Time Factors D016896:Treatment Outcome
cost-effectiveness collaborative care depression anxiety cardiovascular disease