Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity: cluster-randomised trial.

Elizabeth M Camacho,Chris M Dickens,Linda M Davies,Mark Hann,Peter Bower,Nicola Small,Peter Coventry,Chris J Gibbons,Carolyn Chew-Graham,Clare Baguely,Linda Gask,Waquas Waheed,Karina Lovell

doi:10.1192/bjp.2018.70

Abstract

Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.AimsTo explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity. A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service. 191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, -0.48 to -0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069. In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.Declaration of interestNone.

Highlights

Multimorbidity refers to the presence of two or more long-term conditions, which can include combinations of physical and mental symptoms
The COINCIDE trial evaluated the clinical effectiveness of collaborative care over a short-term period (4 months); collaborative care was associated with a significantly greater improvement in Collaborative care for people with mental–physical multimorbidity depression symptoms compared with usual care.[9]
Practices were randomised to collaborative care and to usual care

Summary

Introduction

Multimorbidity refers to the presence of two or more long-term conditions, which can include combinations of physical and mental symptoms. The most widely accepted current definition of collaborative care includes four key criteria: a multi-professional approach to patient care, a structured management plan, scheduled patient follow-ups and enhanced inter-professional communication.[5] A key element is the appointment of a care manager who acts as a conduit between patients and healthcare professionals, and works with the patient to promote better patient self-care.[6] There is some evidence that compared with usual care, collaborative care is more effective for treating depression and anxiety over the short to medium term, with or without multimorbid long-term conditions,[7] but effectiveness beyond 12 months remains uncertain. The UK National Institute for Health and Care Excellence (NICE) concluded that there is currently an absence of clinical or cost-effectiveness evidence for collaborative care in multimorbidity.[8] In the context of interventions for long-term health conditions it is especially important to evaluate long-term clinical effectiveness and cost-effectiveness. Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown

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Conclusion