Jacob T Painter1, John C Fortney, Allen L Gifford, David Rimland, Thomas Monson, Maria C Rodriguez-Barradas, Jeffrey M Pyne. 1. *Center for Mental Healthcare and Outcomes Research Central Arkansas Veterans Healthcare System North Little Rock, AR; †Division of Pharmaceutical Evaluation and Policy University of Arkansas for Medical Sciences Little Rock, AR; ‡South Central Mental Illness Research, Education and Clinical Centers Central Arkansas Veterans Healthcare System North Little Rock, AR; §Psychiatric Research Institute University of Arkansas for Medical Sciences Little Rock, AR; ‖VA New England Healthcare System Center for Healthcare Quality, Outcomes, and Economic Research Bedford, MA; ¶Atlanta VA Medical Center & Department of Infectious Disease Emory University, School of Medicine Atlanta, GA; #Department of Infectious Disease Central Arkansas Veterans Healthcare System North Little Rock, AR; and **Michael E. DeBakey VA Medical Center & Department of Medicine - Infectious Disease Baylor College of Medicine Houston, TX.
Abstract
OBJECTIVE: To examine the cost-effectiveness of the HIV Translating Initiatives for Depression Into Effective Solutions (HITIDES) intervention. DESIGN: Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care. SETTING:Three Veterans Health Administration HIV clinics in the Southern United States. SUBJECTS:Two hundred forty-nine HIV-infected patients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care. INTERVENTION: HITIDES consisted of an offsite HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment, and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines. MAIN OUTCOME MEASURES: Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost-effectiveness ratios (ICERs) and net health benefit. ICER distributions were generated using nonparametric bootstrap with replacement sampling. RESULTS: The HITIDES intervention was more effective and cost saving compared with usual care in 78% of bootstrapped samples. The intervention net health benefit was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY. CONCLUSIONS: In HIV clinic settings, this intervention was more effective and cost saving compared with usual care. Implementation of offsite depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients but also maximizes the efficient use of limited health care resources.
RCT Entities:
OBJECTIVE: To examine the cost-effectiveness of the HIV Translating Initiatives for Depression Into Effective Solutions (HITIDES) intervention. DESIGN: Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care. SETTING: Three Veterans Health Administration HIV clinics in the Southern United States. SUBJECTS: Two hundred forty-nine HIV-infectedpatients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care. INTERVENTION: HITIDES consisted of an offsite HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment, and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines. MAIN OUTCOME MEASURES: Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost-effectiveness ratios (ICERs) and net health benefit. ICER distributions were generated using nonparametric bootstrap with replacement sampling. RESULTS: The HITIDES intervention was more effective and cost saving compared with usual care in 78% of bootstrapped samples. The intervention net health benefit was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY. CONCLUSIONS: In HIV clinic settings, this intervention was more effective and cost saving compared with usual care. Implementation of offsite depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients but also maximizes the efficient use of limited health care resources.
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