Depression Screening RCT in ACS patients: Quality of Life and Cost Outcomes

描述（由申请人提供）：与非抑郁的ACS患者相比，患有急性冠脉综合征（ACS）和共病抑郁的患者复发ACS和死亡的风险高2倍，生活质量差，护理费用高。这些观察结果的强度促使美国心脏协会（AHA）建议对ACS患者进行常规抑郁症筛查，并根据需要进行抑郁症诊断和治疗。不幸的是，没有随机对照试验（RCT）来告知这个大的，可能昂贵的筛查建议。而且，在缺乏RCT证据的情况下，筛查指南/指南最近受到了广泛的批评（并被撤回）。这给临床医生、卫生保健系统和卫生保健政策领导者带来了严重的困境。一个随机对照试验是迫切需要提供的证据，这些不同的组成部分的成本和效益的AHA抑郁症筛查和治疗算法。两个关键的知识空白必须填补，以确定是否会改善公共卫生的AHA策略，抑郁症筛查后ACS患者：1）这一策略是否提高质量调整生命年与最近的ACS患者？2)提供抑郁症筛查和任何类型的抑郁症治疗的费用是否在医疗保健服务可接受的典型报销金额内？我们的具体目标是确定以下AHA的建议抑郁筛查的质量调整生命年效益和医疗保健成本，然后转介进一步诊断和治疗后ACS患者，如果发现抑郁症。为了实现这一目标，我们将患者从三个不同的，地理上不同的健康维护组织随机分为三个不同的组：1）AHA抑郁症筛查和治疗，如果发现抑郁症算法（干预组）或：2）不接受抑郁症筛查（强对照组）或：3）进行筛查并通知初级保健提供者（最低限度增强对照组）。将从所有患者中获得与健康相关的生活质量，抑郁症状和费用，以便比较这三种不同抑郁症筛查策略的收益和成本。

DESCRIPTION (provided by applicant): Patients with an acute coronary syndrome (ACS) and comorbid depression have a 2-fold higher risk for recurrent ACS and mortality, worse quality of life, and higher costs of care than nondepressed ACS patients. The strength of these observational findings prompted the American Heart Association (AHA) to advise that routine depression screening for ACS patients and referral for depression diagnosis and treatment as indicated occur. Unfortunately, there are no randomized controlled trials (RCT) to inform this large, potentially expensive screening recommendation. And, screening guidelines/advisories in the absence of RCT evidence have recently been extensively criticized (and withdrawn). This poses a serious dilemma for clinicians, health care systems, and for health care policy leaders. A RCT is urgently needed to provide evidence for these different constituents about the costs and benefits of the AHA depression screen and treat algorithm. Two critical gaps in knowledge must be filled to determine if public health would be improved by the AHA strategy for depression screening in post-ACS patients: 1) Does this strategy improve quality-adjusted life years for patients with a recent ACS? 2) Is the cost of providing depression screening and any type of depression treatment within the acceptable and typical amounts reimbursed for health care services? Our specific aim is to determine the quality-adjusted life year benefits and health care costs of following the AHA's advisory for depression screening and then referral for further diagnosis and treatment in post-ACS patients, if depression is found. To accomplish this aim, we will randomize patients from three different, geographically diverse health maintenance organizations to three different groups: 1) to the AHA depression screen and treat if depression is found algorithm (intervention group) or: 2) to receive no depression screening (strong control group) or: 3) to be screened and a primary care provider notified (minimally enhanced control group). Health-related quality of life, depressive symptoms, and costs will be obtained from all patients, so that the benefits and the costs of these three different depression screening strategies can be compared.