Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II

Abstract

<b>Objective: </b>We estimated the cost-effectiveness of the Program ACTIVE II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to UC and each other. <p><b>Research Design and Methods: </b>Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the healthcare sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained.</p> <p><b>Results</b>: From the healthcare sector perspective, the EXER intervention strategy saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared to UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention strategy saved $126 (cost-saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses.</p> <p><b>Conclusions: </b>All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the CBT or EXER interventions.</p>