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Randomized Controlled Trial
. 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

Wayne J Katon  1 , Joan E Russo, Michael Von Korff, Elizabeth H B Lin, Evette Ludman, Paul S Ciechanowski
Affiliations
Randomized Controlled Trial

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

Wayne J Katon et al. Diabetes Care. 2008 Jun.

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.

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Figures

Figure 1
Figure 1
Total costs per year over 5 years: case management vs. usual care cost differences.
See this image and copyright information in PMC

References

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    1. Ludman EJ, Katon W, Russo J, Von Korff M, Simon G, Ciechanowski P, Lin E, Bush T, Walker E, Young B. Depression and diabetes symptom burden. Gen Hosp Psychiatry. 2004;26:430–436. - PubMed
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    1. Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, Ciechanowski P, Ludman EJ, Bush T, Young B. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27:2154–2160. - PubMed
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