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Military Tara Lavelle, PhD Assistant Professor, Tufts Medical - - PowerPoint PPT Presentation

Feb 21, 2024 101 likes •423 views

The Cost-Effectiveness of a Collaborative Care Approach to Treating Depression and PTSD in the Military Tara Lavelle, PhD Assistant Professor, Tufts Medical Center Institute for Clinical Research and Health Policy Studies Adjunct Researcher,

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The Cost-Effectiveness of a Collaborative Care Approach to Treating Depression and PTSD in the Military

Tara Lavelle, PhD Assistant Professor, Tufts Medical Center Institute for Clinical Research and Health Policy Studies Adjunct Researcher, The RAND Corporation June 26, 2016

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Collaborators:

  • Mallika Kommareddi, MS, Lisa H. Jaycox, PhD, Charles
  • C. Engel, MD, MPH (RAND Corporation)
  • Bradley Belsher, PhD, Michael C. Freed, PhD
  • Uniformed Services University of the Health

Sciences & Deployment Health Clinical Center at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Funding:

  • Department of Defense Deployment Related Medical

Research Program award (Grant DR080409)

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Acknowledgements

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1/10 military

personnel have mental health diagnosis

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1/5 returning from

combat receive diagnosis of PTSD

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Treatment

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– Medication – Clinical follow-up – Therapy

But…

– Less than half receive mental health services – Often not timely or adequate

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New Approach:

Centrally Assisted Collaborative Telecare (CC)

Case management team

Specialists

Patient

PCP

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New Approach:

Centrally Assisted Collaborative Telecare (CC)

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  • 12-month RCT: CC vs. Optimized Usual

Care (UC)

  • Clinically effective
  • What is cost and is it cost-effective?
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Cost-effectiveness analysis

Incremental cost-effectiveness ratio Effect: Quality Adjusted Life Year (QALY) –Range: 0-1

Cost new treatment -Cost current treatment Effect new treatment - Effect current treatment

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CEA Perspective

Societal Health sector

Caregiver time Work Productivity Family quality of life

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Cost-effectiveness: health sector

Health care Work

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Cost-effectiveness: societal perspective

Health care Work

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METHODS

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12-month health outcomes

Quality of Life

  • SF-12

Survey measurements:

  • Baseline, 3-months, 6-months, and 12-months

Patient QALYs

  • SF-6D

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12-month costs

Intervention:

  • Centralized management team
  • Weekly case management team calls
  • Contacts between nurse coordinator and patient

Other costs:

  • Health Care: Outpatient, inpatient, medications
  • Productivity: Lost work days

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RESULTS

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Baseline Characteristics (n=666)

80% 67% 70% 48%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Male Married Education > High School Race White UC CC

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Cost-effectiveness: health sector

Health care Work

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12-month outcomes

Health Outcomes

  • Patient QALYs

Costs

  • Intervention
  • Inpatient, outpatient, medications

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0.5 0.51 0.52 0.53 0.54 0.55 0.56 0.57 0.58 0.59 0.6 UC CC QALYs

12-month Patient QALYs

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CC > UC 0.02

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12-month outcomes

Health Outcomes

  • Patient QALYs

Costs

  • Intervention
  • Inpatient, outpatient, medications

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$0 $2,000 $4,000 $6,000 $8,000 $10,000 Usual care STEPS-UP

UC CC

12 month health care costs

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Total 12-month costs CC > UC $2200 ~$1800

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Cost-effectiveness: health care perspective

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$110,000 per QALY

∆ QALYs 0.02 ∆ Cost $2200

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What is considered cost-effective?

Country specific

  • USA:

–No explicit threshold –$50,000- $100,000/QALY most commonly cited in literature

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Cost-effectiveness: societal perspective

Health care Work

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12-month outcomes

Health Outcomes

  • Patient QALYs

Costs

  • Intervention
  • Inpatient, outpatient, medications
  • Lost work days

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12 month costs

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$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 Usual Care STEPS-UP UC CC

Productivity costs Usual care> STEPS-UP $1200

12 month costs STEPS-UP > Usual care $1000

Total 12-month costs STEPS-UP > Usual care $2200

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Cost-effectiveness: societal perspective

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$50,000 per QALY

∆ QALYs 0.02 ∆ Cost $1000

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Perspective ∆ Cost ∆ QALY ICER Health System $2200 0.02 $110,000 per QALY Societal $1000 0.02 $50,000 per QALY

Results were sensitive to our decision to include productivity costs…

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Limitations

  • Claims data: Military health system and TRICARE

– No other third party payers – No out of pocket costs

  • 12-month time horizon
  • SF-6D not sensitive to mental health outcomes
  • Did not include impact on other family members

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Conclusions

  • CC cost-effective approach to treating PTSD

and depression in the MHS

  • Consistent with CEA of other collaborative

care models

  • Increased health care integration promotes

efficiency and value, major goals of the Affordable Care Act

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Thank You Questions/Comments

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