The role of economic analyses in promoting adoption of behavioral and psychosocial interventions in clinical settings.

Abstract

In this report, we offer three examples of how economic data could promote greater adoption of behavioral and psychosocial interventions in clinical settings where primary or specialty medical care is delivered to patients. The examples are collaborative care for depression, chronic pain management, and cognitive–behavioral therapy for insomnia. These interventions illustrate differences in the availability of cost and cost-effectiveness data and in the extent of intervention adoption and integration into routine delivery of medical care. Collaborative care has been widely studied from an economic perspective, with most studies demonstrating its relative cost-effectiveness per quality-adjusted life year (QALY) and some studies demonstrating its potential for cost neutrality or cost savings. The success of collaborative care for depression can be viewed as a model for how to promote greater adoption of other interventions, such as psychological therapies for chronic pain and insomnia.

Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

“…This may address previously stated undesirable outcomes associated with current pharmacological provision as ‘go-to’ treatment options for both chronic pain and insomnia management [ 29 – 38 ]. Moreover, there is some evidence demonstrating cost-effectiveness from successful collaborative care models in depression to promote biopsychosocial care models in primary care for chronic pain and insomnia [ 78 ]. Further integration and education of psychological care and PMPs in practices could also meet patients’ described needs and boost clinical adherence [ 74 , 76 ].…”

The Yale Roadmap for Health Psychology and Integrated Cardiovascular Care.

“…The American College of Cardiology and American Heart Association offered guidelines to improve patient-centered and team-based care including via enhanced patient-clinician communication, assessment of patient-centered outcomes and perspectives, shared decision-making, collaborative care planning, and goal setting (Krumholz et al, 2006; Levine et al, 2021; Walsh et al, 2012). As many newer, value-based models integrating behavioral health expertise have only been studied in the primary care setting or in other somatic populations (Bridges et al, 2015; Jacobsen et al, 2019; Woltmann et al, 2012), there is a need to systematically test and quantify integrated care models for CVD in the specialty care setting, where CVD populations, especially the sickest, are primarily managed. Behavioral interventions for cardiovascular specialty populations are cost-effective in randomized controlled trials (Davidson et al, 2013, 2010; Huffman et al, 2014; Kronish et al, 2012; Rollman et al, 2009; Writing Committee for the ENRICHD Investigators, 2003), but we lack systematic, real-world evidence about how programs perform and improve outcomes at practice or health system levels in a cardiovascular specialty service line.…”

Standards for economic analyses of interventions for the field of health psychology and behavioral medicine.

“…The second article considers the value of a collaborative care model that nests mental health providers within primary care practices (Jacobsen et al, 2019). In addition to summarizing the collaborative care model, the article suggests directions for future research in this area and considers how studies incorporating financial and economic outcomes can help foster broader adoption of mental health and psychosocial interventions in medical settings through cost-effective analyses.…”