RT Journal
A1 Katon W, Russo J, Lin EB, et al
T1 Cost-effectiveness of a multicondition collaborative care intervention: A randomized controlled trial
JF Archives of General Psychiatry
JO Archives of General Psychiatry
YR 2012
FD May 1
VO 69
IS 5
SP 506
OP 514
DO 10.1001/archgenpsychiatry.2011.1548
UL http://dx.doi.org/10.1001/archgenpsychiatry.2011.1548
AB Context 
                  Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life.Objective 
                  To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAMcare) compared with usual primary care (UC) in outpatients with depression and poorly controlled diabetes or CHD.Design 
                  Randomized controlled trial of a systematic care management program aimed at improving depression scores and hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels.Setting 
                  Fourteen primary care clinics of an integrated health care system.Patients 
                  Population-based screening identified 214 adults with depressive disorder and poorly controlled diabetes or CHD.Intervention 
                  Physician-supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk factors.Main Outcome Measures 
                  Blinded assessments evaluated depressive symptoms, SBP, and HbA1c at baseline and at 6, 12, 18, and 24 months. Fasting LDL-C concentration was assessed at baseline and at 12 and 24 months. Health plan accounting records were used to assess medical service costs. Quality-adjusted life-years (QALYs) were assessed using a previously developed regression model based on intervention vs UC differences in HbA1c, LDL-C, and SBP levels over 24 months.Results 
                  Over 24 months, compared with UC controls, intervention patients had a mean of 114 (95% CI, 79 to 149) additional depression-free days and an estimated 0.335 (95% CI, −0.18 to 0.85) additional QALYs. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, −$3241 to $2053) relative to UC patients.Conclusions 
                  For adults with depression and poorly controlled diabetes, CHD, or both, a systematic intervention program aimed at improving depression scores and HbA1c, SBP, and LDL-C levels seemed to be a high-value program that for no or modest additional cost markedly improved QALYs.Trial Registration 
                  clinicaltrials.gov Identifier: NCT00468676