Format

Send to

Choose Destination
Diabetes Care. 2008 Jun;31(6):1155-9. doi: 10.2337/dc08-0032. Epub 2008 Mar 10.

Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes.

Author information

1
Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA. wkaton@u.washington.edu

Abstract

OBJECTIVE:

The purpose of this study was to examine the 5-year effects on total health care costs of the Pathways depression intervention program for patients with diabetes and comorbid depression compared with usual primary care.

RESEARCH DESIGN AND METHODS:

The Pathways Study was conducted in nine primary care practices of a large HMO and enrolled 329 patients with diabetes and comorbid major depression. The current study analyzed the differences in long-term medical costs between intervention and usual care patients. Participants were randomly assigned to a nurse depression intervention (n = 164) or to usual primary care (n = 165). The intervention included education about depression, behavioral activation, and a choice of either starting with support of antidepressant medication treatment by the primary care doctor or problem-solving therapy in primary care. Interventions were provided for up to 12 months, and the main outcome measures are health costs over a 5-year period.

RESULTS:

Patients in the intervention arm of the study had improved depression outcomes and trends for reduced 5-year mean total medical costs of -$3,907 (95% CI -$15,454 less to $7,640 more) compared with usual care patients. A sensitivity analysis found that these cost differences were largely explained by the patients with depression and the most severe medical comorbidity.

CONCLUSIONS:

The Pathways depression collaborative care program improved depression outcomes compared with usual care with no evidence of greater long-term costs and with trends for reduced costs among the more severely medically ill patients with diabetes.

PMID:
18332158
PMCID:
PMC3810023
DOI:
10.2337/dc08-0032
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center