Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions:A randomized controlled trial in the general hospital setting (CC-DIM)

The study was undertaken to establish if collaborative care (CC) is a cost-effective treatment model when provided in the general hospital outpatient setting, rather than the primary care setting, for patients with chronic physical conditions, such as diabetes mellitus (DM), chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD), with comorbid major depressive disorder (MDD). The researchers performed a randomized controlled trial (RCT) evaluating CC provided by a consultant psychiatric nurse (CPN) as care manager; a consultation–liaison (CL) psychiatrist for diagnosis, supervision, and the prescription of antidepressant medication; and a medical specialist who provided treatment for the chronic physical condition. They found CC to be cost-effective with an incremental cost-effectiveness ratio (ICER) of €24,690 per quality-adjusted life year (QALY). Due to the high disease burden in this patient group, this may indicate that the CC model and setting may be preferable. However, the study was small, so replication in a larger study is warranted.