In the Journals

Enhanced depression care following ACS found cost effective in COPES trial

Cost benefits may exist with enhanced depression care following acute coronary syndrome, compared with usual care, according to an analysis of results from the Coronary Psychosocial Evaluation Studies.

Researchers evaluated the effectiveness of enhanced depression care as compared with usual care in patients with ACS and persistent depressive symptoms 3 months after discharge. Estimates were then determined using 6-month outcomes. Enhanced depression care was defined as patient preference for problem-solving psychotherapy, antidepressant use or both.

At 6-month follow-up, patients in the enhanced depression care group had greater improvements in health utility, although not statistically significant, compared with the usual care group. However, patients in the enhanced depression care group also used ambulatory services less often and had lower hospitalization rates for major adverse cardiac events and HF, which led to cost savings. The cost savings may offset the higher costs of mental health care, according to the research.

“Mean total health care costs, including costs for psychotropic medications, ambulatory care and hospitalizations, totaled $1,857 for the enhanced depression care group and $2,797 for the usual care group (adjusted difference, −$1,229 per patient; 95% CI, −$2,652 to $195).

“Because the intervention was cost saving on average, no mean cost-effectiveness ratio exists. Bootstrap analysis demonstrated that if society is willing to pay $30,000 per quality-adjusted life-year gained by enhanced depression care, the probability that this treatment approach will be considered cost-effective is 98%,” the researchers wrote.

Disclosure: This study was supported by National Heart, Lung and Blood Institute grants. The researchers report no relevant financial disclosures.

Cost benefits may exist with enhanced depression care following acute coronary syndrome, compared with usual care, according to an analysis of results from the Coronary Psychosocial Evaluation Studies.

Researchers evaluated the effectiveness of enhanced depression care as compared with usual care in patients with ACS and persistent depressive symptoms 3 months after discharge. Estimates were then determined using 6-month outcomes. Enhanced depression care was defined as patient preference for problem-solving psychotherapy, antidepressant use or both.

At 6-month follow-up, patients in the enhanced depression care group had greater improvements in health utility, although not statistically significant, compared with the usual care group. However, patients in the enhanced depression care group also used ambulatory services less often and had lower hospitalization rates for major adverse cardiac events and HF, which led to cost savings. The cost savings may offset the higher costs of mental health care, according to the research.

“Mean total health care costs, including costs for psychotropic medications, ambulatory care and hospitalizations, totaled $1,857 for the enhanced depression care group and $2,797 for the usual care group (adjusted difference, −$1,229 per patient; 95% CI, −$2,652 to $195).

“Because the intervention was cost saving on average, no mean cost-effectiveness ratio exists. Bootstrap analysis demonstrated that if society is willing to pay $30,000 per quality-adjusted life-year gained by enhanced depression care, the probability that this treatment approach will be considered cost-effective is 98%,” the researchers wrote.

Disclosure: This study was supported by National Heart, Lung and Blood Institute grants. The researchers report no relevant financial disclosures.