Cost-effectiveness of a collaborative care program for primary care patients with persistent depression
Cost-effectiveness of a collaborative care program for primary care patients with persistent depression
复制标题
DOI：
10.1176/appi.ajp.158.10.1638
复制
发表时间：
2001-10-01
影响因子：
17.7
通讯作者：
Ludman, E
中科院分区：
文献类型：
--
作者：
Simon, GE;Katon, WJ;Ludman, E
目的：作者评估了在常规初级保健管理后对持续抑郁症状的患者进行分级协作护理的增量成本效益。方法：开始抗抑郁治疗的初级保健患者在初次处方后 6-8 周完成标准化电话评估。那些患有持续性重性抑郁或显着阈下抑郁症状的患者被随机分配到继续常规护理或协作护理。协作护理包括系统的患者教育、咨询精神科医生的初次就诊、精神科医生和初级保健医生共同护理 2-4 个月，以及监测随访和遵守药物治疗方案。在 1、3 和 6 个月时通过盲法电话评估来评估临床结果。通过健康计划索赔和会计数据评估健康服务的利用率和成本。结果：接受协作护理的患者在 6 个月内平均增加了 16.7 天的无抑郁天数。该计划中抑郁症治疗的平均增量成本为 357 美元。额外费用归因于抗抑郁药处方和门诊费用增加。没有观察到使用其他卫生服务的抵消性减少。每个无抑郁日增量成本效益为 21.44 美元。结论。针对抑郁症初级保健患者的分步协作护理计划显着提高了治疗效果，并适度增加了费用。这些发现与其他随机试验的结果一致。改善初级保健中抑郁症治疗的结果需要投入额外的资源，但这项投资的回报与许多其他广泛接受的医疗干预措施的回报相当。
objective: The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management.Method: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks after the initial prescription. Those with persistent major depression or significant subthreshold depressive symptoms were randomly assigned to continued usual care or collaborative care. The collaborative care included systematic patient education, an initial visit with a consulting psychiatrist, 2-4 months of shared care by the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Clinical outcomes were assessed through blinded telephone assessments at 1, 3, and 6 months. Health services utilization and costs were assessed through health plan claims and accounting data.Results: Patients receiving collaborative care experienced a mean of 16.7 additional depression-free days over 6 months. The mean incremental cost of depression treatment in this program was $357. The additional cost was attributable to greater expenditures for antidepressant prescriptions and outpatient visits. No offsetting decrease in use of other health services was observed. The incremental cost-effectiveness was $21.44 per depression-free day.Conclusions. A stepped collaborative care program for depressed primary care patients led to substantial increases in treatment effectiveness and moderate increases in costs. These findings are consistent with those of other randomized trials. Improving outcomes of depression treatment in primary care requires investment of additional resources, but the return on this investment is comparable to that of many other widely accepted medical interventions.