Abstract: Objective: To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians’ usual care (UC).Methods: We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone two-weeks following hospitalization (9-item Patient Health Questionnaire ?10), and were randomized to either an 8-month centralized, nurse-provided, and telephone-delivered collaborative care (CC) intervention for depression or to their physicians’ usual care (UC).Results: At 12-months following randomization, CC patients had $2,068 lower but statistically similar estimated median costs compared to UC (P=0.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost effectiveness ratio of CC was -$9,889 (-$11,940 to -$7,838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY.

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Importance There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance. Objective To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties. Design, Setting, and Participants We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not

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New guidelines have been developed by the Physicians Committee for Responsible Medicine. Outside experts say a healthy diet and exercise is always good advice, but evidence that this will reduce Alzheimer’s risk is lacking. Medscape Medical News

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More control over their schedules and fewer hassles with third-party payers may explain why psychiatrists suffer less from burnout than most other physicians. Medscape Medical News

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