Julie M Donohue1, Bea Herbeck Belnap2, Aiju Men1, Fanyin He3, Mark S Roberts4, Herbert C Schulberg5, Charles F Reynolds3, Bruce L Rollman6. 1. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. 2. Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 3. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 4. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 5. Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA. 6. Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: rollmanbl@upmc.edu.
Abstract
OBJECTIVE: To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians' usual care (UC). METHODS: We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone 2 weeks following hospitalization (nine-item Patient Health Questionnaire ≥10) and were randomized to either an 8-month centralized, nurse-provided and telephone-delivered CC intervention for depression or to their physicians' UC. RESULTS: At 12 months following randomization, CC patients had $2068 lower but statistically similar estimated median costs compared to UC (P=.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost-effectiveness ratio of CC was -$9889 (-$11,940 to -$7838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane also demonstrated a 68% probability of CC "dominating" UC (more QALYs at lower cost). CONCLUSIONS: Centralized, nurse-provided and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care.
RCT Entities:
OBJECTIVE: To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians' usual care (UC). METHODS: We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone 2 weeks following hospitalization (nine-item Patient Health Questionnaire ≥10) and were randomized to either an 8-month centralized, nurse-provided and telephone-delivered CC intervention for depression or to their physicians' UC. RESULTS: At 12 months following randomization, CC patients had $2068 lower but statistically similar estimated median costs compared to UC (P=.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost-effectiveness ratio of CC was -$9889 (-$11,940 to -$7838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane also demonstrated a 68% probability of CC "dominating" UC (more QALYs at lower cost). CONCLUSIONS: Centralized, nurse-provided and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care.
Authors: Kenneth E Freedland; Judith A Skala; Robert M Carney; James M Raczynski; C Barr Taylor; Carlos F Mendes de Leon; Gail Ironson; Marston E Youngblood; K Ranga Rama Krishnan; Richard C Veith Journal: Psychosom Med Date: 2002 Nov-Dec Impact factor: 4.312
Authors: Jürgen Unützer; Wayne Katon; Christopher M Callahan; John W Williams; Enid Hunkeler; Linda Harpole; Marc Hoffing; Richard D Della Penna; Polly Hitchcock Noël; Elizabeth H B Lin; Patricia A Areán; Mark T Hegel; Lingqi Tang; Thomas R Belin; Sabine Oishi; Christopher Langston Journal: JAMA Date: 2002-12-11 Impact factor: 56.272
Authors: N Frasure-Smith; F Lespérance; G Gravel; A Masson; M Juneau; M Talajic; M G Bourassa Journal: J Psychosom Res Date: 2000 Apr-May Impact factor: 3.006
Authors: Virginie Pignay-Demaria; François Lespérance; Roland G Demaria; Nancy Frasure-Smith; Louis P Perrault Journal: Ann Thorac Surg Date: 2003-01 Impact factor: 4.330
Authors: James A Blumenthal; Heather S Lett; Michael A Babyak; William White; Peter K Smith; Daniel B Mark; Robert Jones; Joseph P Mathew; Mark F Newman Journal: Lancet Date: 2003-08-23 Impact factor: 79.321
Authors: Bea Herbeck Belnap; Amy Anderson; Kaleab Z Abebe; Ravi Ramani; Matthew F Muldoon; Jordan F Karp; Bruce L Rollman Journal: Psychosom Med Date: 2019 Jul/Aug Impact factor: 4.312
Authors: Suzanne H Richards; Lindsey Anderson; Caroline E Jenkinson; Ben Whalley; Karen Rees; Philippa Davies; Paul Bennett; Zulian Liu; Robert West; David R Thompson; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2017-04-28
Authors: Bruce L Rollman; Bea Herbeck Belnap; Sati Mazumdar; Kaleab Z Abebe; Jordan F Karp; Eric J Lenze; Herbert C Schulberg Journal: J Gen Intern Med Date: 2016-10-06 Impact factor: 5.128
Authors: Lauren A Waterman; Bea Herbeck Belnap; Marie Anne Gebara; Yan Huang; Kaleab Z Abebe; Bruce L Rollman; Jordan F Karp Journal: Ann Clin Psychiatry Date: 2020-02 Impact factor: 1.567