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

Katon, Wayne; Unützer, Jürgen; Fan, Ming; Williams, John W; Schoenbaum, Michael; Lin, Elizabeth; Hunkeler, Enid M.

doi:10.2337/diacare.29.02.06.dc05-1572

Cited by 231 publications

(197 citation statements)

References 39 publications

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“…The ADA recommends depression assessment and treatments into routine diabetes care [3]. Randomized clinical trials have demonstrated that the integrated management of type 2 diabetes and depression could improve both medication adherence and symptoms of diabetes and depression [28], and screening and enhanced treatment regimens for depression could lead to not only better health outcomes but also cost savings compared to "usual care" [29][30][31]. Implementing ADA recommendations and effective interventions demonstrated in the clinical trials could reduce the excess financial burden of MDD among persons with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Shrestha

Zhang

et al. 2013

Diabetes Research and Clinical Practice

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Aim-We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM).Methods-We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities.Results-Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure.Conclusions-Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population.

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Section: Discussionmentioning

confidence: 99%

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Shrestha

Zhang

et al. 2013

Diabetes Research and Clinical Practice

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“…Although the IMPACT model has previously been shown to be effective in older populations with diabetes (8), this is the first study to examine a fully integrated program. It is also the first study of IMPACT depression care management in a population of largely Spanish-speaking Latinos.…”

Section: Research Design Andmentioning

confidence: 99%

“…Project Dulce has been shown to improve diabetes outcomes among low-income, predominately Spanish-speaking Latinos with diabetes in San Diego County (6). Similarly, the IMPACT model has been shown to improve depression outcomes (7,8). Our goals were to assess the feasibility of a combined program in a lowincome setting, to demonstrate reductions in depressive symptoms, and to estimate costs of the intervention in a pilot study in three community clinics.…”

mentioning

confidence: 99%

Improving Treatment of Depression Among Latinos With Diabetes Using Project Dulce and IMPACT

et al. 2008

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OBJECTIVE -To assess the feasibility and cost of integrating diabetes and depression care management in three community clinics serving a low-income and predominately Spanishspeaking Latino population.RESEARCH DESIGN AND METHODS -We screened diabetes patients for depression, and for those with depressive symptoms, we provided depression care management. We assessed changes in depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), diabetes self-care activities (nutrition, exercise, and medication adherence), and costs.RESULTS -Thirty-three percent of patients with diabetes had symptoms of major depression. Among 99 patients completing the study, PHQ-9 scores declined by an average of 7.5 points from 14.8 to 7.3 (P Ͻ 0.001). Clients averaged 6.7 visits with the care manager during the study period. Costs of depression care management were estimated to be $512 per participant.CONCLUSIONS -Adding a depression care manager to an existing diabetes management team was effective at reducing depressive symptoms at a reasonable cost.

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“…Also older patients showed greater cost-offset effects (21,22). Von Korff and colleagues (23) found a costoffset in specialty mental health care for patients with major depression, but not for general medical services. Patients with diabetes and depression who received a stepped collaborative care intervention had greater mental health service costs, but non-mental health medication costs and other outpatient costs were lower.…”

Section: Introductionmentioning

confidence: 99%

Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records

Zentner

Baumgartner

Becker

et al. 2015

Int J Health Policy Manag

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Background: There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time. Methods: Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self-reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI-EU) for two 6-month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication. Results: Sixty-one participants completed both assessments. Over one year, the average patient-reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = -2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status. Conclusion: Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of posthospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs. Keywords: Health Service Costs, Administrative Data, Self-Report, Mental Health Services Copyright: © 2015 by Kerman University of Medical Sciences Citation: Zentner N, Baumgartner I, Becker T, Puschner B. Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records.

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

Cited by 231 publications

References 39 publications

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Improving Treatment of Depression Among Latinos With Diabetes Using Project Dulce and IMPACT

Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records

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