Christopher M Celano1, Brian Healy2, Laura Suarez3, Douglas E Levy4, Carol Mastromauro3, James L Januzzi2, Jeff C Huffman5. 1. Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. Electronic address: ccelano@partners.org. 2. Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA. 3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 4. Harvard Medical School, Boston, MA, USA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA. 5. Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Abstract
OBJECTIVE: To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization. METHODS: The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs. RESULTS: The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs. CONCLUSIONS: This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge.
RCT Entities:
OBJECTIVE: To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization. METHODS: The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs. RESULTS: The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs. CONCLUSIONS: This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge.
Authors: Sarah E Woolf-King; Alexandra Anger; Emily A Arnold; Sandra J Weiss; David Teitel Journal: J Am Heart Assoc Date: 2017-02-01 Impact factor: 5.501
Authors: Juliana Zambrano; Christopher M Celano; James L Januzzi; Christina N Massey; Wei-Jean Chung; Rachel A Millstein; Jeff C Huffman Journal: J Am Heart Assoc Date: 2020-11-07 Impact factor: 5.501
Authors: Waguih William IsHak; Samuel Korouri; Tarneem Darwish; Brigitte Vanle; Jonathan Dang; Gabriel Edwards; Jeanne T Black; Harriet Aronow; Asher Kimchi; Brennan Spiegel; Rebecca Hedrick; Robert Chernoff; Marcio A Diniz; James Mirocha; Vicki Manoukian; John Harold; Michael K Ong; Kenneth Wells; Michele Hamilton; Itai Danovitch Journal: PLoS One Date: 2021-01-07 Impact factor: 3.240
Authors: Karin du Plessis; Rebecca Peters; Ingrid King; Kirsty Robertson; Jonathan Mackley; Rachel Maree; Tracy Stanley; Louise Pickford; Brian Rose; Matthew Orchard; Helen Stewart; Yves d'Udekem Journal: Int J Cardiol Heart Vasc Date: 2018-03-09