title: Is treatment of depression cost-effective in people with diabetes? A systematic review of the economic evidence.
abstract: OBJECTIVE
  Depression is common in diabetes and linked to a wide range of adverse outcomes. UK policy indicates that depression should be treated using conventional psychological treatments in a stepped care framework. This review aimed to identify current economic evidence of psychological treatments for depression among people with diabetes.
  
  
  METHODS
  Electronic search strategies (conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, NHS EED) combined clinical and economic search terms to identify full economic evaluations of the relevant interventions. Prespecified screening and inclusion criteria were used. Standardized data extraction and critical appraisal were conducted and the results summarized qualitatively.
  
  
  RESULTS
  Excluding duplicates, 1,516 studies for co-morbid depression and diabetes were screened. Four economic evaluations were identified. The studies found that the interventions improved health status, reduced depression and were cost-effective compared with usual care. The studies were all U.S.-based and evaluated collaborative care programs that included psychological therapies. Critical appraisal indicated limitations with the study designs, analysis and results for all studies.
  
  
  CONCLUSIONS
  The review highlighted the paucity of evidence in this area. The four studies indicated the potential of interventions to reduce depression and be cost-effective compared with usual care. Two studies reported costs per QALY gained of USD 267 to USD 4,317, whilst two studies reported the intervention dominated usual care, with net savings of USD 440 to USD 612 and net gains in patient free days or QALYs.
authors.affiliation: Collaboration for Leadership in Applied Health Research and Care for Greater Manchester.
authors.forename: Farheen
authors.initials: F
authors.lastname: Jeeva
authors.forename: Christopher
authors.initials: C
authors.lastname: Dickens
authors.forename: Peter
authors.initials: P
authors.lastname: Coventry
authors.forename: Christine
authors.initials: C
authors.lastname: Bundy
authors.forename: Linda
authors.initials: L
authors.lastname: Davies
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000150:complications / Q000191:economics / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years