Objective: To examine the cost-effectiveness of the HIV
Translating Initiatives for Depression Into Effective Solutions (HITIDES)
intervention.
Setting: Three Veterans Health Administration HIV clinics in
the Southern United States.
Subjects: Two hundred forty-nine HIV-infected patients
completed the baseline interview; 123 were randomized to the intervention and
126 to usual care.
HITIDES consisted of an offsite HIV depression care team
that delivered up to 12 months of collaborative care. The intervention used a
stepped-care model for depression treatment, and specific recommendations were
based on the Texas Medication Algorithm Project and the VA/Department of
Defense Depression Treatment Guidelines.
Quality-adjusted life years (QALYs) were calculated using
the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by
converting depression-free days to QALYs. The base case analysis used
outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was
calculated using incremental cost-effectiveness ratios (ICERs) and net health
benefit. ICER distributions were generated using nonparametric bootstrap with
replacement sampling.
The HITIDES intervention was more effective and cost saving
compared with usual care in 78% of bootstrapped samples. The intervention net
health benefit was positive and therefore deemed cost-effective using an ICER
threshold of $50,000/QALY.
In HIV clinic settings, this intervention was more effective
and cost saving compared with usual care. Implementation of offsite depression
collaborative care programs in specialty care settings may be a strategy that
not only improves outcomes for patients but also maximizes the efficient use of
limited health care resources.
Purchase full article at: http://goo.gl/fVPqo3
By: Painter JT1, Fortney JC, Gifford AL, Rimland D, Monson T, Rodriguez-Barradas MC, Pyne JM.
1*Center for Mental Healthcare and Outcomes
Research Central Arkansas Veterans Healthcare System North Little Rock, AR;
†Division of Pharmaceutical Evaluation and Policy University of Arkansas for
Medical Sciences Little Rock, AR; ‡South Central Mental Illness Research,
Education and Clinical Centers Central Arkansas Veterans Healthcare System
North Little Rock, AR; §Psychiatric Research Institute University of Arkansas
for Medical Sciences Little Rock, AR; ‖VA New England Healthcare System Center
for Healthcare Quality, Outcomes, and Economic Research Bedford, MA; ¶Atlanta
VA Medical Center & Department of Infectious Disease Emory University,
School of Medicine Atlanta, GA; #Department of Infectious Disease Central
Arkansas Veterans Healthcare System North Little Rock, AR; and **Michael E.
DeBakey VA Medical Center & Department of Medicine - Infectious Disease
Baylor College of Medicine Houston, TX.
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