Abstract
BackgroundDespite the high prevalence of subthreshold depression in patients with type 2 diabetes, evidence on cost-effectiveness of different therapy options for these patients is currently lacking.Methods/DesignWithin-trial economic evaluation of the diabetes-specific cognitive behaviour therapy for subthreshold depression. Patients with diabetes and subthreshold depression are randomly assigned to either 2 weeks of diabetes-specific cognitive behaviour group therapy (n = 104) or to standard diabetes education programme only (n = 104). Patients are followed for 12 months. During this period data on total health sector costs, patient costs and societal productivity costs are collected in addition to clinical data. Health related quality of life (the SF-36 and the EQ-5D) is measured at baseline, immediately after the intervention, at 6 and at 12 months after the intervention. Quality adjusted life years (QALYs), and cumulative costs will be estimated for each arm of the trial. Cost-effectiveness of the diabetes-specific cognitive behaviour group therapy will be analysed from the perspective of the German statutory health insurance and from the societal perspective. To this end, incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained will be calculated.DiscussionSome methodological issues of the described economic evaluation are discussed.Trial registrationThe trial has been registered at the Clinical Trials Register (NCT01009138).
Highlights
Despite the high prevalence of subthreshold depression in patients with type 2 diabetes, evidence on cost-effectiveness of different therapy options for these patients is currently lacking
Previous research demonstrates that comorbid depression in patients with diabetes is associated with poor self care, i.e. adherence to medication, diet, exercise and smoking cessation [6,7,8], additive functional impairment and work disability [9], poorer glycaemic control [10], higher risk of microvascular and
Additional costs for improved depression treatment could be offset by reduction in other healthcare costs
Summary
Despite the high prevalence of subthreshold depression in patients with type 2 diabetes, evidence on cost-effectiveness of different therapy options for these patients is currently lacking. Depression is a highly prevalent disorder with a substantial impact on quality of life and societal cost [1,2]. This applies in particular to patients with diabetes, since depression has been shown to be more prevalent among these patients as compared to those without diabetes [3,4,5]. In the IMPACT trial [20] for example, systematic depression treatment in older adults with diabetes had significant clinical benefit with no increase in overall healthcare costs. The Pathways Study [21] found that over a 2-year period the increased costs associated with enhanced mental health treatment were offset by savings in total medical expenditures
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