Mental Health

Latinos benefit more than whites from psychotherapy-based quality improvement for depression, and they have lower costs for care

Latinos are less likely than whites to receive care for depression and even less likely to receive quality depression care. However, they benefit even more from improved care for depression, and enhanced resources for psychotherapy for depression was highly cost-effective for Latino patients. These are new findings from the Partners in Care (PIC) randomized controlled trial to improve care for depression in managed primary care settings. PIC is supported in part by the Agency for Healthcare Research and Quality (HS08349) and led by Kenneth Wells, M.D., M.P.H., of the University of California, Los Angeles.

The study involved 46 primary managed care clinics, 181 primary care providers, and 398 Latino and 778 white patients with current depression. The researchers compared outcomes of white and Latino patients who were randomized to usual care or to one of two interventions designed to increase the rate of effective depression treatment. One intervention was focused on medication management, (QI-Meds) and the other intervention was focused on psychotherapy (QI-Therapy). Clinicians and patients could choose the type of treatment or no treatment.

In QI-Meds, trained nurses provided followup assessments and support for adherence to antidepressant medication for 6 to 12 months. In QI-Therapy, therapy copayments were reduced to the amount charged for primary care visits for visits to local psychotherapists who had been trained to perform cognitive behavioral therapy. QI-Therapy was highly cost effective for Latino patients, due both to very positive outcomes (fewer days burdened by depression) and to very modest costs. In contrast, QI-Meds did not improve depression burden or quality of life for Latino patients and thus was not cost effective. Relative to usual care, QI-Therapy resulted in increased days employed for white patients—more than 5 work weeks over 2 years.

The estimated cost per quality-adjusted life year (QALY) for Latinos was $6,100 or less under QI-Therapy but $90,000 or more for QI-Meds. Estimated costs per QALY for white patients were around $30,000 under both interventions, within the range of other accepted medical interventions. The researchers suggest that the benefits of improved care may be particularly strong for Latino patients due to their low treatment rates under usual care.

See "Cost-effectiveness of interventions for depressed Latinos," by Michael Schoenbaum, Ph.D., Jeanne Miranda, Ph.D., Cathy Sherbourne, Ph.D., and others, in the Journal of Mental Health Policy and Economics 7, pp. 69-76, 2004.

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