Team Care for Depressed Older Adults Cuts Overall Medical Costs
• Science Update
A team approach to depression treatment for older adults, already shown to be effective, is also less expensive than usual care, according to an NIMH-funded study published February 2008 in the American Journal of Managed Care.
Clinical depression affects about 3 million older adults in the United States and is associated with 50 to 70 percent higher healthcare expenses.1
Previous studies reported that the collaborative care program in the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) trial was substantially more effective than usual care for older adults with depression.2 In the trial, 1,801 adults age 60 and older were randomized either to the collaborative care program, in which a trained care manager worked with the participant’s regular doctor to actively treat the participant’s depression, or to usual care, in which participants were encouraged to follow up on their own for treatment. After one year of treatment, those in the collaborative care group had significantly lower rates of depression than those assigned to the usual care group. The intervention group continued to have lower rates of depression 12 months after the trial’s end.
Previous economic analyses found that costs were slightly higher for collaborative care participants during the initial year of treatment, but they decreased slightly in the second year follow-up. In this current study, Jurgen Unutzer, M.D., MPH, of the University of Washington, and colleagues analyzed the total economic costs of IMPACT over four years using a sample of 551 participants. Total costs included all outpatient, inpatient and prescription medication costs for both medical and mental health care. They found that the collaborative care group’s costs were $3,363 less than the usual care group ($29,422 vs. $32,785). Costs were lower in the collaborative care group mostly because participants sought fewer medical care services.
“IMPACT has provided strong evidence that not only is a collaborative care program more effective at fighting depression in this vulnerable population, it also is a wise financial investment, “said Dr. Unutzer.
Unutzer J, Katon WJ, Fan MY, Schoenbaum M, Lin EHB, Della Penna R, Powers D. Long-term cost effects of collaborative care for late-life depression. American Journal of Managed Care. 2008 Feb; VOL(#):pp-pp.
1Katon WJ, Lin E, Russo J, Unützer J.Increased medical costs of a population-based sample of depressed elderly patients. Archives of General Psychiatry. Sep 2003;60(9):897-903.
2Unutzer WJ, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. Journal of the American Medical Association. 2002 Dec 11; 288(22):2836-2845.