Collaborative Care is Effective and Cost-Effective For Adolescent Depression

MedicalResearch.com Interview with:

Laura P. Richardson, MD, MPH Interim Chief | Division of Adolescent Medicine Director | UW Leadership Education in Adolescent Health (LEAH) Program Professor | UW Department of Pediatrics Seattle Children's | University of Washington

Dr. Laura Richardson

Laura P. Richardson, MD, MPH
Interim Chief | Division of Adolescent Medicine
Director | UW Leadership Education in Adolescent Health (LEAH) Program
Professor | UW Department of Pediatrics
Seattle Children’s | University of Washington

MedicalResearch.com: What is the background for this study?

Response: Adolescent depression is one of the most common mental health conditions during adolescence. Up to one in five adolescents experience an episode of major depression by age 18. Depressed youth are at greater risk of suicide, dropping out of school and poor long-term health. Treatments, including medications and psychotherapy, have been proven to be effective but most depressed teens don’t receive any treatment.

Two years ago, we showed that the Reaching Out to Adolescents in Distress (ROAD) collaborative care model (a.k.a. Reach Out 4 Teens) designed to increase support and the delivery of evidence-based treatments in primary care was effective in treating depression in teens, significantly improving outcomes. We ran a randomized clinical trial at nine of Group Health’s primary care clinics and reported effectiveness results in JAMA.

The current paper represents the next step in this work, examining the cost-effectiveness of collaborative care for adolescent depression in our intervention sample of 101 adolescents with depression, ages 13-17 years.

MedicalResearch.com: What are the main findings?

Response: In this study, we found that, even by the most conservative benchmarks that health care economists use for willingness to pay, this collaborative care model is a cost-effective approach for treating teen depression:
• Collaborative care resulted in an increase of 0.04 QALY over usual care, at a cost of $883 above usual care—only marginally more expensive.
• The mean adjusted incremental cost-effectiveness ratio was $18,239 per QALY. This is well within the realm of what is widely considered a worthwhile level to pay for improving health outcomes.

MedicalResearch.com: What should readers take away from your report?

Response: Collaborative care for depression in adults has repeatedly proven effective and cost-effective in randomized controlled trials—and it is being used in routine practice in many sites around the world. Our prior study, and others, found collaborative care to be significantly more effective than usual care for adolescent depression. Now, we have data to suggest that the cost of adding this care is relatively small, especially in light of the significant impact that treating depression has on improving symptoms and quality of life for teens.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We now know that collaborative care is effective and cost-effective for adolescent depression, the next steps in this work are to develop strategies to encourage the uptake of collaborative care in order to improve outcomes and reduce burden for depressed teens.

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