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Telephone-delivered collaborative care for depression treatment after CABG reduced costs
A telephone-delivered intervention led by nurses to treat depression after CABG was associated with lower costs at 1 year compared with usual care.
Researchers conducted the Bypassing the Blues trial to evaluate the cost-effectiveness and outcomes of a collaborative care intervention in which a nurse care manager telephoned patients to review their psychiatric history, provide basic education about depression and describe treatment options. The care manager then presented the patient’s information to a psychiatrist and internist at a weekly case-review session. Based on that session, treatment recommendations were sent to the patient’s primary care provider.
The study included 189 patients who screened positive for depression after CABG who were randomly assigned to the collaborative care intervention or usual care for 8 months.
Researchers for the Bypassing the Blues trial previously reported that patients assigned the collaborative care intervention had higher levels of health-related quality of life measures, lower levels of mood disorder symptoms and lower levels of pain compared with patients assigned usual care.
The present findings reported cost-effectiveness measures at 12 months following randomization. Median costs for the collaborative care intervention group were $2,068 lower than for the usual care group ($16,126 vs. $18,194; P=.3). Sensitivity analyses did not change the results, according to the researchers.
The incremental cost-effectiveness ratio of the collaborative care intervention was –$9,889 (95% CI, –$11,940 to –$7,838) per additional quality-adjusted life-year.
“This is … the first report to describe a statistically significant negative [incremental cost-effectiveness ratio] for a [collaborative care] strategy for treating depression in any patient population,” the researchers wrote.
The researchers also reported a 90% probability that the collaborative care intervention would be cost-effective at the willingness-to-pay threshold of $20,000 per additional quality-adjusted life-year.
When the researchers performed a bootstrapped cost-effectiveness plane, they found a 68% probability of the collaborative care intervention providing more quality-adjusted life-years at lower cost compared with the usual care.
“One of the holy grails in mental health services research is to demonstrate that treating a common mental health condition such as depression is not only effective and cost-effective, but also cost-saving. This is the first trial to demonstrate all three outcomes,” Bruce L. Rollman, MD, MPH, from the University of Pittsburgh School of Medicine, said in a press release. “We now know that screening for and then providing effective depression treatment to medically complex patients with [CVD] is very likely to pay for itself.”
An American Heart Association science advisory recommends routine screening and treatment of depression in patients with cardiac disease, according to Rollman.
Disclosure: The study was funded by the NIH and The Fine Foundation. The researchers report no relevant financial disclosures.