TREATMENT COSTS, COST OFFSET, AND COST-EFFECTIVENESS OF COLLABORATIVEMANAGEMENT OF DEPRESSION

Objective: This report estimates the treatment costs, cost-offset effe cts, and cost-effectiveness of Collaborative Care of depressive illnes s in primary care. Study Design: Treatment costs, cost-offset effects, and cost-effectiveness were assessed in two randomized, controlled tr ials. In the first randomized trial (N = 217), consulting psychiatrist s provided enhanced management of pharmacotherapy and brief psychoeduc ational interventions to enhance adherence. In the second randomized t rial (N = 153), Collaborative Care was implemented through brief cogni tive-behavioral therapy and enhanced patient education. Consulting psy chologists provided brief psychotherapy supplemented by educational ma terials and enhanced pharmacotherapy management. Results: Collaborativ e Care increased the costs of treating depression largely because of t he extra visits required to provide the interventions. There was a mod est cost offset due to reduced use of specialty mental health services among Collaborative Care patients, but costs of ambulatory medical ca re services did not differ significantly between the intervention and control groups. Among patients with major depression there was a modes t increase in cost-effectiveness. The cost per patient successfully tr eated was lower for Collaborative Care than for Usual Care patients. F or patients with minor depression, Collaborative Care was more costly and not more cost-effective than Usual Care. Conclusions: Collaborativ e Care increased depression treatment costs and improved the cost-effe ctiveness of treatment for patients with major depression. A cost offs et in specialty mental health costs, but not medical care costs, was o bserved. Collaborative Care may provide a means of increasing the valu e of treatment services for major depression.