Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes
Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes
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DOI：
10.2337/dc08-0032
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发表时间：
2008-06-01
期刊：
影响因子：
16.2
通讯作者：
Ciechanowski, Paul S.
中科院分区：
文献类型：
--
作者：
Katon, Wayne J.;Russo, Joan E.;Ciechanowski, Paul S.
目的-本研究的目的是检查与普通初级保健相比，Pathways抑郁干预计划对糖尿病和共病抑郁症患者的总医疗保健成本的5年影响。研究设计和方法-Pathways研究在一家大型HMO的9个初级保健诊所进行，招募了329名糖尿病和共病重度抑郁症患者。本研究分析了干预和常规护理患者之间长期医疗费用的差异。参与者被随机分配到护士抑郁干预组（n = 164）或常规初级护理组（n = 165）。干预措施包括有关抑郁症的教育，行为激活，以及选择由初级保健医生支持抗抑郁药物治疗或在初级保健中解决问题的治疗。干预措施提供了长达12个月，和主要的结果措施是健康成本超过5年的periods.RESULTS -患者在干预臂的研究有改善抑郁症的结果和趋势，减少5年的平均总医疗费用-3,907美元（95%CI-15,454美元，7,640美元以上）相比，通常的护理患者。一项敏感性分析发现，这些成本差异在很大程度上解释了抑郁症患者和最严重的医疗comormorphis.CONCLUSIONS -的路径抑郁症协作护理计划改善抑郁症的结果相比，没有证据表明更大的长期成本和降低成本的趋势，更严重的医学疾病糖尿病患者的常规护理。
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 meical 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.