Addressing depression and anxiety in primary care improves chronic pain management

A study published this month in the American Journal of Managed Care explores how integrating behavioral health care into primary care can improve outcomes and be cost-effective for adults with depression, anxiety and chronic pain who are on long-term opioid therapy.

The care was delivered by a multidisciplinary team-a community health worker, a licensed clinical social worker and a clinical pharmacist-via telemedicine. Eboni Price-Haywood, MD, MPH, MMM, FACP, system medical director for Health Outcomes & Inclusion at Ochsner Health, is a lead author.

About the study

The study was conducted to compare the cost-effectiveness of behavioral health integration (BHI) in primary care versus usual care (clinical decision support) for adult patients with depression and/or anxiety taking chronic opioid therapy for noncancer pain.

Researchers analyzed data from 632 adult patients in Louisiana during a trial conducted between April 2019 and June 2022. They used decision tree analysis to assess costs related to interventions, acute care, outpatient visits and prescriptions. Health outcomes were measured using quality-adjusted life-years (QALYs) and reductions in opioid dosage (measured as morphine equivalent daily dose, or MEDD).

Key findings

Better value for better health: Behavioral health integration cost $10,489.19 per patient annually compared to $5,673.96 for usual care. While BHI was more expensive upfront, it resulted in 0.0439 additional QALYs, yielding an incremental cost-effectiveness ratio (ICER) of $108,784 per QALY. This falls within the US-based willingness-to-pay threshold of $100,000 to $150,000 per QALY, making it a cost-effective option.

Reducing opioid use: Patients in the BHI group reduced their opioid dosage by 7.3 mg/day, while those in usual care saw an increase of 2.0 mg/day. The cost of achieving a 1 mg/day reduction in opioid use was $514, highlighting the effectiveness of BHI in addressing opioid dependency.

What drives costs: Prescription medications (like antidepressants and pain relievers) and visits with primary care providers and social workers were the biggest cost factors. Sensitivity analyses confirmed that these were the most influential drivers of cost-effectiveness.

Smarter care, lower costs: By shifting care to more affordable settings and reducing reliance on emergency or acute care, BHI supports the goals of expanding access and improving quality. 

Integrating behavioral health into primary care not only improves patient outcomes but also addresses critical gaps in access to mental health services. This study demonstrates that investing in multidisciplinary care teams and telemedicine can lead to smarter, more sustainable healthcare delivery."

Eboni Price-Haywood, MD, MPH, MMM, FACP, Study Lead Author and System Medical Director, Health Outcomes & Inclusion, Ochsner Health

Conclusions

Behavioral health integration in primary care is a cost-effective approach from a health system perspective. It not only improves mental health outcomes but also reduces opioid use and prescription drug expenses, which are the primary drivers of savings. This model of care highlights how targeted investments in mental health can transform healthcare delivery for the better.