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 ϭ 204) versus usual care (n ϭ 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 Ϫ1,638 to 1,689) higher during this same period. The incremental cost per depression-free day was 25 cents (Ϫ$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.
Diabetes Care 29:265-270, 2006P atients with diabetes have a high rate of major depression, estimated at 11-15% (1). Depression in patients with diabetes is associated with higher medical symptom burden (2), additive functional impairment (3,4), poor selfcare (adherence to diet, exercise, cessation of smoking, and medications) (5), a higher number of cardiac risk factors (6), increased macrovascular and microvascular complications, and higher mortality (7).Given the adverse effects of depression on medical symptom burden and self-care of diabetes, it is not surprising that patients with depression and diabetes have significantly higher medical costs than patients with diabetes alone after controlling for severity of diabetes and medical comorbidity (8). Although several trials have shown that depression can be adequately treated in patients with comorbid diabetes and depression (9,10), there is only one study that has reported the incremental cost-effectiveness of improving depression care in patients with diabetes compared with those treated in usual primary care (11). This study showed a high probability that the increased costs of improving care of depression were associated with larger savings in medical costs (i.e., a cost offset effect) (11). However, this trial occurred in one large HMO in one geographic area of the country, and the findings need to be replicated.The Improving Mood-Promoting Access to Collaborative (IMPACT) trial recently reported the incremental costeffectivene...