Building the Business Case: Cost-Effectiveness Studies of Collaborative Care
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.
- Jurgen Unutzer et al., “Long-term Cost Effects of Collaborative Care for Late-life Depression”, American Journal of Managed Care 14, no. 2 (2008): 95-100.
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.
- Grypma l, Haverkamp R, Little S, Unützer J. "Taking an evidence-based model of depression care from research to practice: making lemonade out of depression." General Hospital Psychiatry 28, no. 2 (2007): 101-7.
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.
- Wayne Katon et al., “Cost-Effectiveness and Net Benefit of Enhanced Treatment of Depression for Older Adults with Diabetes and Depression,” Diabetes Care 29, no. 2 (2006): 265-70.
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.”
- Gregory Simon et al., “Cost-effectiveness of Systematic Depression Treatment Among People With Diabetes Mellitus,” Archives of General Psychiatry 64, no. 1 (2007): 65-72.
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.
- Wayne Katon et al., “Long-Term Effects on Medical Costs of Improving Depression Outcomes in Patients with Depression and Diabetes," Diabetes Care 31, no. 6 (2008): 1155-9.