title: Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression.
abstract: 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.
  
  
  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 = 204) versus usual care (n = 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 dollars (95% CI -1,638 to 1,689) higher during this same period. The incremental cost per depression-free day was 25 cents (-14 dollars to 15 dollars) and the incremental cost per quality-adjusted life year ranged from 198 dollars (144-316) to 397 dollars (287-641). An incremental net benefit of 1,129 dollars (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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195-6560, USA. wkaton@u.washington.edu
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Enid M
authors.initials: EM
authors.lastname: Hunkeler
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000150:complications / Q000191:economics* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000523:psychology / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years
chemical_list: D000928:Antidepressive Agents