Long-Term Effects on Medical Costs of Improving Depression Outcomes in Patients with Depression and Diabetes

Abstract

Objective: 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 to usual primary care.

Research Design and Methods: The Pathways trial was conducted in 9 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 (PST-PC). 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 -$3907 (95% CI -$15,454 less to $7640 more) compared to usual care patients. A sensitivity analysis found that these cost differences were largely explained by the patients with depression and the most severe medical comorbidity.

Conclusion: The Pathways depression collaborative care program improved depression outcomes compared to 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.