Project ImPACT: Depression
Aggregated, de-identified data was collected for general demographics, economic outcomes, and clinical outcomes from 130 of the 159 patients enrolled.
The clinical outcomes analysis compared initial and follow-up results that were collected during the course of patient care primarily using PHQ-9, a validated depression assessment tool. PHQ-9 is a survey that addresses the presence and severity of each of the nine symptoms included in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, diagnostic criteria for major depression.
Interpretation of PHQ-9 Total Scores
- Less than 5: suggests the patient probably does not require treatment
- 5 to 14: implies that the provider should use clinical judgment in considering the necessity of treatment.
- Greater than 14: strongly suggests that some form of evidence-based treatment is warranted
Interpretation of PHQ-9 Clinical Outcomes
- Treatment response is defined as a decrease of 50% or more from the baseline score.
- Treatment remission is defined as a PHQ-9 score of less than 5.
- 80% of patients exhibited a decrease in PHQ-9 scores between the baseline visit and the most recent follow-up; 8% had no change in depression severity; and 12% of patients worsened in depression severity.
- In general, clinical improvements and outcomes were superior for patients with severe depression (PHQ-9 score > 14): 83% with severe depression achieved remission; 20% with mild or moderate symptoms achieved remission.
- Overall, 56% of the 130 patients achieved remission.
Before the program was implemented, the self-insured employers provided the actual 1-year cost of care for the participants during the year prior. They also provided the projected total cost of care for the study year for those same patients based on trend data. The economic outcomes analysis compared the actual cost of care during the 1-year project to the projected costs of care if the program had not been implemented.
- Baseline mean total health care costs to the employer per patient per year was $7,935, and employers projected the 48 evaluable patients would have an average total cost of care of $9,023, if no program was implemented.
- At the end of the 1-year evaluation, the actual mean total health care costs per patient were $8,040, a savings of $983 per patient per year.
- The majority of costs savings were due to a decline in medical costs, which were projected to amount to $5,353 per patient annually, but actual mean values were $3,600 (33% lower than projected).
- Annual employer costs for prescription medications increased by 21% compared with the projected costs ($3,670 vs. $4,440/patient).
- Individual out-of-pocket costs for prescriptions decreased by 41% ($323/patient) compared with projected estimates, due to waived copayment incentives. However, enrollee out-of-pocket medical costs increased by 24% ($434/patient) above projected values.
- Payment for pharmacists’ services and waived copayments were included as an increased cost to the employer while calculating the net savings.