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Cost-effectiveness of Collaborative Care for Depression in Human Immunodeficiency Virus Clinics
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  • Alternative Title:
    J Acquir Immune Defic Syndr
  • Description:

    To examine the cost-effectiveness of the HITIDES intervention.


    Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care.


    Three Veterans Health Administration (VHA) HIV clinics in the Southern US.


    249 HIV-infected patients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care.


    HITIDES consisted of an off-site HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines.

    Main outcome measure(s)

    Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost effectiveness ratios (ICERs) and net health benefit (NHB). ICER distributions were generated using nonparametric bootstrap with replacement sampling.


    The HITIDES intervention was more effective and cost-saving compared to usual care in 78% of bootstrapped samples. The intervention NHB was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY.


    In HIV clinic settings this intervention was more effective and cost-saving compared to usual care. Implementation of off-site depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients, but also maximizes the efficient use of limited healthcare resources.

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