ABSTRACT: Estimated treatment costs, cost-offset effects, and cost-effectiveness of collaborative care (CC) of depressive illness in primary care in 2 randomized controlled trials. In the 1st trial, with 217 depressed patients, psychiatrists provided enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence. In the 2nd trial, with 153 depressed patients, CC was implemented through brief cognitive-behavioral therapy and enhanced patient education. Consulting psychologists provided brief psychotherapy supplemented by educational materials and enhanced pharmacotherapy management. CC increased the costs of treating depression largely because of the extra visits required to provide the interventions. There was a modest cost offset due to reduced use of specialty mental health services among CC patients, but costs of ambulatory medical care serviced did not differ significantly between the intervention and control groups. Among Ss with major depression there was a modest increase in cost-effectiveness. The cost per patient successfully treated was lower for CC than for usual care patients. For patients with minor depression, CC was morecostly and not more cost-effective than usual care.
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