Cost-effectiveness of systematic depression treatment among people with diabetes mellitus
Cost-effectiveness of systematic depression treatment among people with diabetes mellitus
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DOI：
10.1001/archpsyc.64.1.65
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Young, Bessie A.
中科院分区：
文献类型：
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作者：
Simon, Gregory E.;Katon, Wayne J.;Young, Bessie A.
内容：糖尿病合并抑郁症与更高的医疗服务费用有关，这表明更有效的抑郁症治疗可能会减少其他医疗服务的使用。目的：评估门诊糖尿病患者系统性抑郁症治疗计划的增量成本和成本效益。设计：随机对照试验，比较系统性抑郁症治疗计划与常规护理。设定：小组模式预付健康计划的初级保健诊所。患者：2阶段筛选过程确定了329名患有糖尿病和当前抑郁症的成年人。干预：专业护士提供了一个为期12个月的阶梯式抑郁症治疗计划，从解决问题的治疗心理治疗或结构化的抗抑郁药物治疗计划开始。随后的治疗（结合心理治疗和药物治疗，调整药物治疗，专科转诊）进行调整，根据临床responsibility.Main结果措施：抑郁症状进行了评估，盲电话评估在3，6，12和24个月。使用健康计划会计记录评估卫生服务成本。在24个月的时间里，被分配到干预组的患者平均多了61天没有抑郁症（95%置信区间[ CI]，11至82天），门诊医疗服务费用平均少314美元（95% CI，1007美元减少到379美元增加）与继续接受常规治疗的患者相比。当一个额外的一天免费的抑郁症的价值为10美元，干预的净经济效益是952美元每名患者治疗（95%CI，244美元至1660美元）。结论：对于成年糖尿病患者，系统的抑郁症治疗显着增加时间免费的抑郁症，似乎有显着的经济效益从健康计划的角度来看。抑郁症筛查和系统的抑郁症治疗应该成为糖尿病护理的常规组成部分。
Context: Depression co-occurring with diabetes mellitus is associated with higher health services costs, suggesting that more effective depression treatment might reduce use of other medical services.Objective: To evaluate the incremental cost and cost-effectiveness of a systematic depression treatment program among outpatients with diabetes.Design: Randomized controlled trial comparing systematic depression treatment program with care as usual. Setting: Primary care clinics of group-model prepaid health plan.Patients: A 2-stage screening process identified 329 adults with diabetes and current depressive disorder.Intervention: Specialized nurses delivered a 12-month, stepped-care depression treatment program beginning with either problem-solving treatment psychotherapy or a structured antidepressant pharmacotherapy program. Subsequent treatment ( combining psychotherapy and medication, adjustments to medication, and specialty referral) was adjusted according to clinical response.Main Outcome Measures: Depressive symptoms were assessed by blinded telephone assessments at 3, 6, 12, and 24 months. Health service costs were assessed using health plan accounting records.Results: Over 24 months, patients assigned to the intervention accumulated a mean of 61 additional days free of depression ( 95% confidence interval [ CI], 11 to 82 days) and had outpatient health services costs that averaged $314 less ( 95% CI, $1007 less to $379 more) compared with patients continuing in usual care. When an additional day free of depression is valued at $10, the net economic benefit of the intervention is $952 per patient treated ( 95% CI, $244 to $1660).Conclusions: For adults with diabetes, systematic depression treatment significantly increases time free of depression and appears to have significant economic benefits from the health plan perspective. Depression screening and systematic depression treatment should become routine components of diabetes care.