Team care for depression in elderly cost-effective

A collaborative care management program for late-life depression leads to significantly better health outcomes over 2 years and is more cost-effective than usual care for depression, new study findings show.

"We found a cost-effective way of providing evidence-based treatment to patients with depression, within the primary care setting," lead investigator Dr. Wayne J. Katon told Reuters Health.

The Improving Mood Promoting Access to Collaborative Treatment (IMPACT) trial intervention used either a nurse or psychologist care manager, and a choice of treatment with an antidepressant drug or a 6- to 8-session counseling program.

Included in the study were 1801 patients age 60 or older treated at 1 of 18 primary care clinics. The subjects, all of whom were diagnosed with major depression or dysthymia or both, were randomly assigned to the IMPACT intervention or to usual care.

Katon, a psychiatrist at the University of Washington School of Medicine in Seattle, and his associates report their results in the Archives of General Psychiatry.

The researcher noted that approximately two thirds of the subjects in the IMPACT arm received antidepressant medications.

"About half of the patients in the (comparison) group were exposed to antidepressants, but often at only one dose, so they were never switched off that dose or switched to another medication when the first one didn't work," he added. "What we saw with the intervention was higher quality antidepressant care, as well as provision of evidence-based brief therapy."

Patients in the IMPACT arm experienced 107 additional depression-free days over a 2-year period compared with patients in the usual care arm.

"It cost $145 more per year to provide this intervention, resulting in a dramatic effect in terms of people's depression-free days and improved quality of life and improved functioning," Katon said.

"About half the costs (of the program) are medication costs and the other half are the cost of more visits with the case manager," he added. "Those costs are mostly offset by savings in medical costs."

The incremental cost was approximately $2.76 per depression-free day, the authors report.

Katon said that his group had received "a lot of requests from health care organizations to help them institute this model of care, and we have received funding from the John A. Hartford Foundation to do these consultations."

SOURCE: Archives of General Psychiatry, December 2005.