Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders

Unützer, Jürgen; Patrick, Donald L.; Diehr, Paula; Simon, Greg; Grembowski, David; Katon, Wayne

doi:10.1017/s1041610200006177

Cited by 175 publications

(130 citation statements)

References 30 publications

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“…Based on available estimates of depression and QALYs (25)(26)(27)(28)(29)(30), the increase in depression-free days of 115.4 was associated with the IMPACT intervention corresponds to an estimate of 0.063 (95% CI 0.039 -0.087) to 0.126 (0.079 -0.174) QALYs. Combining the QALY estimates with the point estimate for incremental outpatient costs yields a cost per QALY range of $198 (95% CI 144 -316) to $397 (287-641) associated with the IMPACT intervention.…”

Section: Resultsmentioning

confidence: 99%

“…Prior literature (25)(26)(27)(28)(29)(30) has suggested that going from fully symptomatic to full remission of depression is associated with an increase in quality of life from 0.2 to 0.4 on a scale of 0 (no quality) to 1 (full quality). To determine the incremental QALYs associated with the intervention, we divided the 2-year difference in depression-free days by 365 and then multiplied by the lower (0.2) and upper (0.4) bound increases in QALYs associated with full remission of depression in the literature (25)(26)(27)(28)(29)(30). The resulting range of QALYs was then divided into the point estimate for incremental total outpatient costs to estimate costs per QALY associated with the intervention versus usual care.…”

Section: Outcome Measuresmentioning

confidence: 99%

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

et al. 2006

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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...

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Section: Resultsmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

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

et al. 2006

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“…The main symptoms of patients with AS are pain, stiffness and physical restriction, and all these negations influence the quality of life [14]. The anxiety and depression seen in chronic disease may also contribute to decreased quality of life caused by the disease itself [42]. In this regard, education level is also important since patients with more information on their disorders have more favourable outcome [14].…”

Section: Discussionmentioning

confidence: 99%

Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis

et al. 2010

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Our aim in this study was to compare the depression and anxiety risk in patients with AS and healthy controls and also to determine the relationship between disease activity, quality of life and psychological well-being. Two hundred and forty-three patients with ankylosing spondylitis (AS) and 118 age-, sex- and education-matched healthy controls were enroled into the study. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Functional Index, and Metrology Index, Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), Hospital Anxiety and Depression Scale (HADS) including depression subscale (HADS-D) and anxiety subscale (HADS-A), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, duration of morning stiffness, pain-visual analogue scale (VAS), patient and physician's global assessment of disease activity (100 mm VAS) were used to assess clinical and psychological status. Patients had similar HADS-D but higher HADS-A than healthy controls. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI and also poorer scores in VAS pain, patient global assessment, physician global assessment, HAQ-S and ASQoL. There was a negative correlation of HADS-D and HADS-A scores with educational level of the patients. Higher scores in HADS-D and HADS-A indicated poorer functional outcome and quality of life. Multivariate logistic regression analysis revealed that the HADS-D (OR=6.84), HAQ-S (OR=1.76), VAS pain score (OR=1.03) and ESR (OR=1.02) were independent risk factors for higher anxiety scores whereas HADS-A (OR=1.36) and ASQoL (OR=1.24) were independent risk factors for higher depression scores. The psychological status had close interaction with disease activity and quality of life in patients with AS.

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“…In addition, improvements in HRQL have been observed to accompany improvements in depressive symptoms [37,38]. Although we did not measure severity of depressive symptoms, this has also been shown to have an inverse relationship with HRQL independent of age, sex and chronic conditions [39,40].…”

Section: Discussionmentioning

confidence: 99%

Measuring health status and decline in at-risk seniors residing in the community using the Health Utilities Index Mark 2

et al. 2006

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Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders

Cited by 175 publications

References 30 publications

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

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

Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis

Measuring health status and decline in at-risk seniors residing in the community using the Health Utilities Index Mark 2

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