2012 Articles

Cost-effectiveness of Enhanced Depression Care After Acute Coronary Syndrome: Results From the Coronary Psychosocial Evaluation Studies Randomized Controlled Trial

Ladapo, Joseph A.; Shaffer, Jonathan A.; Fang, Yixin; Ye, Siqin; Davidson, Karina W.

Depression following an acute coronary syndrome (ACS) affects 2 in 5 patients and is one of the most important psychosocial predictors of a poor cardiovascular prognosis.1 In the Coronary Psychosocial Evaluation Studies (COPES) randomized controlled trial, we compared the effectiveness of enhanced depression care, which comprised patient preference for problem-solving psychotherapy, antidepressant use, or both, through the use of a stepped-care algorithm, with usual care in patients with ACS and persistent depressive symptoms 3 months after discharge.2 The 6-month trial demonstrated that enhanced depression care improved patient satisfaction with treatment and reduced depressive symptoms. However, the intervention's impact on health-related quality of life, health care utilization, and cost-effectiveness has not been evaluated. To help bridge this gap and inform decision making, we undertook a cost-effectiveness analysis of enhanced depression treatment in patients with ACS and persistent depressive symptoms using results from the COPES trial.