Building the Business Case: Cost-Effectiveness Studies of Collaborative Care

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Numerous collaborative care trials and studies have demonstrated that the Collaborative Care model has consistently shown high value and are cost effective. Cost-effectiveness has tended to improve over time for higher-cost patients with depression, as clinical improvement in depression contributes to reduced emergency room visits and hospitalizations over time.

The IMPACT (Improving Mood and Promoting Access to Collaborative Treatment) model showed a savings of $3,365 per patient (n = 272) over patients receiving usual primary care over a four-year period, even though the intervention ended after one year.

Patients participating in the IMPACT trial of depression collaborative care for older adults had lower mean total health care costs than patients who received usual care over the four year period. The IMPACT study suggested that up to $6 are saved in long term health care costs for patients for every dollar spent on collaborative care, a return on investment of 6:1.

A study that implemented an adapted version of IMPACT for all adults found that the post-study group (n=172) had lower annualized total health care costs ($7,471) per patient (excluding pharmacy) than the usual care and intervention groups in the original IMPACT trial.

In a study of adult patients with diabetes and depression, researchers found that those who received depression collaborative care had an incremental net benefit of $1,129 over two years of treatment. The study concluded that this intervention is “a high-value investment for older adults with diabetes.” Collaborative care was associated with high clinical benefits at no greater cost than usual care.

Over the course of a two year study at Group Health, patients with diabetes and depression who were assigned to a stepped-care depression treatment program had outpatient health services costs that averaged $314 less than those who received usual care. The authors conclude that “for adults with diabetes, systematic depression treatment appears to have significant economic benefits from the health plan perspective.”

Primary care patients with diabetes and major depression assigned to an intervention program including education about depression, behavioral activation and a choice between anti-depressant medication or problem-solving therapy had improved depression outcomes compared to the usual care group with no evidence of greater long-term costs.