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Invited Commentary
Nov 26, 2012

Coping With Rising Health Care Costs Comment on “Cost-effectiveness of Enhanced Depression Care After Acute Coronary Syndrome”

Author Affiliations

Author Affiliations: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Ziegelstein); Departments of Psychiatry, Counseling and Educational Psychology, Epidemiology, Biostatistics, and Occupational Health, and Medicine and School of Nursing, McGill University, and Lady Davis Institute for Medical Research, Jewish General Hospital (Dr Thombs), Montreal, Quebec, Canada.

Arch Intern Med. 2012;172(21):1684-1685. doi:10.1001/2013.jamainternmed.114

The Coronary Psychosocial Evaluation Studies (COPES) randomized controlled trial examined patient satisfaction with depression care (the primary outcome) and depressive symptom reduction, major adverse cardiac events that required hospitalization, and death (secondary outcomes) associated with treatment of depressed mood that persisted at least 3 months after an acute coronary syndrome (ACS).1 In the COPES trial, patients with ACS were evaluated soon after their acute cardiac event with the Beck Depression Inventory (BDI), and individuals with a score of 10 or more were then reassessed 3 months later. Patients with persistent symptoms (BDI score of ≥10 at 3 months) were then randomized to usual care by the patients' treating physicians or to 6 months of a patient preference-based, stepped-care intervention that offered problem-focused psychotherapy or antidepressant medication. The COPES trial reported that enhanced depression care improved patient satisfaction with treatment and reduced depressive symptoms compared with usual care. The report by Ladapo et al2 suggests that these promising results can be realized while simultaneously reducing health care costs.

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