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Diabetes Care 29:265-270, 2006
DOI: 10.2337/diacare.29.02.06.dc05-1572
© 2006 by the American Diabetes Association
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Epidemiology/Health Services/Psychosocial Research
Original Article

Cost-Effectiveness and Net Benefit of Enhanced Treatment of Depression for Older Adults With Diabetes and Depression

Wayne Katon, MD1, Jürgen Unützer, MD, MPH1, Ming-Yu Fan, PHD1, John W. Williams, Jr, MD, MHS2, Michael Schoenbaum, PHD3, Elizabeth H.B. Lin, MD, MPH4 and Enid M. Hunkeler, MA5

1 Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
2 Department of Medicine, Durham Veterans Administration Medical Hospital, Durham, North Carolina
3 RAND, Arlington, Virginia
4 Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
5 Kaiser Permanente, Oakland, California

Address correspondence and reprint requests to Wayne Katon, MD, Department of PsychiatryBehavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195-6560. E-mail: wkaton{at}u.washington.edu

OBJECTIVE—To determine the incremental cost-effectiveness and net benefit of a depression collaborative care program compared with usual care for patients with diabetes and depression.

RESEARCH DESIGN AND METHODS—This article describes a preplanned subgroup analysis of patients with diabetes from the Improving Mood-Promoting Access to Collaborative (IMPACT) randomized controlled trial. The setting for the study included 18 primary care clinics from eight health care organizations in five states. A total of 418 of 1,801 patients randomized to the IMPACT intervention (n = 204) versus usual care (n = 214) had coexisting diabetes. A depression care manager offered education, behavioral activation, and a choice of problem-solving treatment or support of antidepressant management by the primary care physician. The main outcomes were incremental cost-effectiveness and net benefit of the program compared with usual care.

RESULTS—Relative to usual care, intervention patients experienced 115 (95% CI 72–159) more depression-free days over 24 months. Total outpatient costs were $25 (95% CI –1,638 to 1,689) higher during this same period. The incremental cost per depression-free day was 25 cents (–$14 to $15) and the incremental cost per quality-adjusted life year ranged from $198 (144–316) to $397 (287–641). An incremental net benefit of $1,129 (692–1,572) was found.

CONCLUSIONS—The IMPACT intervention is a high-value investment for older adults with diabetes; it is associated with high clinical benefits at no greater cost than usual care.

Abbreviations: DCM, depression care manager • HSCL-20, Hopkins Symptom Checklist 20 Depression Scale • IMPACT, Improving Mood-Promoting Access to Collaborative • PST-PC, problem-solving treatment developed for primary care • QALY, quality-adjusted life year


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Copyright © 2006 by the American Diabetes Association.