Rural Collaborative Depression Care May Not be Cost-Effective

Telemedicine team care approach in rural clinics more costly per QALY than similar urban programs
By Lindsey Marcellin
HealthDay Reporter

WEDNESDAY, Aug. 4 (HealthDay News) -- Rural clinic-based collaborative interventions for depression delivered via telemedicine are more costly in terms of quality-adjusted life year (QALY) ratios than similar programs delivering collaborative depression care in urban areas, according to research published in the August issue of the Archives of General Psychiatry.

Jeffrey M. Pyne, M.D., of the University of Arkansas for Medical Sciences in Little Rock, and colleagues conducted a randomized controlled trial comparing a collaborative-team telemedicine intervention for depression in rural areas to a usual-care telemedicine intervention without the collaborative team approach. The study included seven Veterans Health Administration community-based outpatient clinics in rural areas of the mid-South.

The researchers found no significant differences between the two groups in incremental depression-free days. In the intervention group, health-related quality of life -- as measured by the Quality of Well-being scale -- improved significantly more than in the usual care group at six months but not 12 months. The mean base case incremental cost-effectiveness ratio was $85,634/QALY for the collaborative approach. The authors concluded that this cost per QALY ratio was greater than the $50,000/QALY threshold reported for other mostly urban depression collaborative care interventions.

"The base case analysis mean cost per QALY ratio was $85,634/QALY, is greater than cost per QALY ratios reported for other mostly urban collaborative care interventions for depression targeting primarily female patient populations, and is less than cost per QALY thresholds for intervention adoption that have been suggested more recently. Individuals with depression who have poor access to mental health care specialists are deserving of high-quality depression care just like their urban counterparts. The future challenge will be to improve the efficiency of similar interventions to further enhance adoption," the authors write.

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