title: 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.
  
  
  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.
authors.affiliation: Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA 90089, USA. jhay@usc.edu
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ell
authors.forename: Pey-Jiuan
authors.initials: PJ
authors.lastname: Lee
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Guterman
mesh_terms: D000328:Adult; D015897:Comorbidity; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D054521:Cultural Competency; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology; D048909:Diabetes Complications / Q000191:economics / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology; D005260:Female; D017048:Health Care Costs / Q000145:classification; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D015141:Los Angeles; D008297:Male; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000191:economics*; D011203:Poverty; D011795:Surveys and Questionnaires; D055815:Young Adult