For heart bypass surgery patients, combining depression screening with follow-up “collaborative care” phone calls from a nurse not only improves health-related quality of life, physical functioning, and mood symptoms, but also lowers medical costs.
While previous research showed this collaborative care model to be effective for treating post-coronary artery bypass graft (CABG) depression, the new study establishes the “business case” to policy makers and insurers for widespread adoption, researchers say.
“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 is also cost-saving,” says Bruce L. Rollman, professor of medicine, psychiatry, and clinical and translational science at the University of Pittsburgh School of Medicine and principal investigator of the trial.
“This is the first trial to demonstrate all three outcomes. We now know that screening for and then providing effective depression treatment to medically complex patients with cardiovascular disease is very likely to pay for itself.”
A recent American Heart Association science advisory already recommends routine screening and treatment of depression in patients with cardiac disease.
BETTER QUALITY OF LIFE
For the new study, published in the journal General Hospital Psychiatry, researchers examined Medicare and private medical insurance claims data for 189 trial participants. After incorporating the $460 average cost to deliver the intervention that included nurse and supervising physician time, patients randomly assigned to the intervention had $2,068 lower median claims costs at one year after bypass surgery compared to those who received their doctors’ usual care ($16,126 vs. $18,194).
The intervention was also highly cost-effective, producing more quality-adjusted life-years (QALY), a measure analysts use to determine the value of different medical actions, while significantly lowering medical claims costs by $9,889 per additional QALY generated, a first for a collaborative care strategy for treating depression in any patient population.
About 400,000 CABG surgeries are performed annually in the US, and studies indicate approximately one in five patients who undergo the procedure experience clinical depression. Extending this $2,068 savings to all depressed post-CABG patients has the potential to save more than $165 million in medical claims in the first year following surgery, Rollman says.
The collaborative care model involves care managers who follow an evidence-based treatment protocol under the supervision of a primary care physician. The team systematically contacts patients to monitor their mood symptoms and recommends appropriate adjustments in treatment.
Although team-based collaborative care for depression has yet to be widely adopted, it is increasingly being provided by integrated health care systems through “patient-centered medical homes” supported by payment reforms under the Affordable Care Act.
Other researchers from University of Pittsburgh and from Weill Cornell Medical College collaborated on the study.
The Fine Foundation and the National Institutes of Health supported the study.
《Twelve-month cost-effectiveness of telephone-delivered collaborative care for treating depression following CABG surgery: a randomized controlled trial》, Published on Journal 《General Hospital Psychiatry》in May 23, 2014.