Cost-Effectiveness Analysis of Collaborative Care Management of Major Depression among Low-Income, Predominantly Hispanics with Diabetes

Abstract Objective To evaluate the cost-effectiveness of a socioculturally adapted collaborative depression care program among low-income Hispanics with diabetes. Research design and methods A randomized controlled trial of 387 patients with diabetes (96.5% Hispanic) with clinically significant depr...

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Veröffentlicht in:Value in health 2012-03, Vol.15 (2), p.249-254
Hauptverfasser: Hay, Joel W., PhD, Katon, Wayne J., MD, Ell, Kathleen, DSW, Lee, Pey-Jiuan, MS, Guterman, Jeffrey J., MD, MS
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Sprache:eng
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Zusammenfassung:Abstract Objective To evaluate the cost-effectiveness of a socioculturally adapted collaborative depression care program among low-income Hispanics with diabetes. Research design and methods A randomized controlled trial of 387 patients with diabetes (96.5% Hispanic) with clinically significant depression followed over 18 months evaluated the cost-effectiveness of the Multifaceted Diabetes and Depression Program aimed at increasing patient exposure to evidence-based depression psychotherapy and/or pharmacotherapy in two public safety net clinics. Patient medical care costs and utilization were captured from Los Angeles County Department of Health Services claims records. Patient-reported outcomes included Short-Form Health Survey-12 and Patient Health Questionnaire-9-calculated depression-free days. Results Intervention patients had significantly greater Short-Form Health Survey-12 utility improvement from baseline compared with controls over the 18-month evaluation period (4.8%; P < 0.001) and a corresponding significant improvement in depression-free days (43.0; P < 0.001). Medical cost differences were not statistically significant in ordinary least squares and log-transformed cost regressions. The average costs of the Multifaceted Diabetes and Depression Program study intervention were $515 per patient. The program's cost-effectiveness averaged $4053 per quality-adjusted life-year per MDDP recipient and was more than 90% likely to fall below $12,000 per quality-adjusted life-year. Conclusions Socioculturally adapted collaborative depression care improved utility and quality of life in predominantly low-income Hispanic patients with diabetes and was highly cost-effective.
ISSN:1098-3015
1524-4733
DOI:10.1016/j.jval.2011.09.008