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Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial
Wayne Katon1, Joan Russo, Elizabeth H B Lin
1Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. wkaton@uw.edu
Archives of General Psychiatry
|May 9, 2012
Summary
This study found that the TEAMcare intervention improved depression and chronic disease management for adults with depression and diabetes or heart disease. The program offered high value, improving quality-adjusted life-years (QALYs) with no or modest additional costs.
Area of Science:
- Health Services Research
- Chronic Disease Management
- Mental Health Interventions
Background:
- Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both experience higher medical complication rates and healthcare costs.
- Effective management of comorbid psychiatric and medical conditions may reduce healthcare utilization and improve quality of life.
Purpose of the Study:
- To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAMcare) compared to usual primary care (UC).
- To assess the impact of TEAMcare on depression scores, hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels in outpatients with depression and poorly controlled diabetes or CHD.
Main Methods:
- A randomized controlled trial was conducted across 14 primary care clinics within an integrated healthcare system.
- 214 adults with depressive disorder and poorly controlled diabetes or CHD were identified via population-based screening.
- The intervention involved physician-supervised nurses collaborating with primary care physicians to manage multiple disease risk factors, with blinded assessments of outcomes over 24 months.
Main Results:
- Intervention patients experienced an average of 114 additional depression-free days over 24 months compared to UC controls.
- The TEAMcare program yielded an estimated 0.335 additional quality-adjusted life-years (QALYs) per patient.
- Outpatient healthcare costs were lower for intervention patients, with a mean difference of $594 per patient.
Conclusions:
- The systematic TEAMcare intervention program is a high-value approach for adults with depression and poorly controlled diabetes or CHD.
- The program significantly improved QALYs with no or modest additional costs.
- This collaborative treatment model effectively enhances both mental health and chronic disease management.
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