Cost-Effectiveness and Net Benefit of Enhanced Treatment of Depression for Older Adults With Diabetes and Depression

Epidemiology/Health Services/Psychosocial Research

¹Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
²Department of Medicine, Durham Veterans Administration Medical Hospital, Durham, North Carolina
³RAND, Arlington, Virginia
⁴Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
⁵Kaiser Permanente, Oakland, California

Address correspondence and reprint requests to Wayne Katon, MD, Department of PsychiatryBehavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195-6560. E-mail: wkaton{at}u.washington.edu

Article Figures & Tables

Table 1—

Patient characteristics

Characteristic	Diabetes subgroup
Characteristic		Usual care (n = 214)	Intervention (n = 204)
Female	112 (52)	111 (54)
Mean age (years)	70.2 ± 0.5	70.1 ± 0.5
Married or living with partner	103 (48)	93 (46)
Ethnic group
White	136 (64)	132 (65)
African American	39 (18)	46 (23)
Hispanic	33 (15)	21 (10)
Other	6 (3)	5 (2)
At least high school graduate	160 (75)	150 (74)
Mean annual income (in $1000s)	26.0 (1.7)	27.5 (2.4)
Depression status (SCID diagnosis)
Major depression	27 (13)	24 (12)
Dysthymia	61 (28)	59 (29)
Major depression and dysthymia	126 (59)	121 (59)
Mean HSCL-20 depression score (range 0–4) (±SE)	1.7 ± 0.04	1.7 ± 0.01
Mean chronic disease score	7.9 ± 0.3	7.5 ± 0.3
Mean duration of diabetes	11.6 ± 0.7	10.5 ± 0.7
Diabetes treatment
Diet only	26 (12)	36 (18)
Oral hypoglycemic agents only	110 (51)	96 (47)
Insulin only	50 (23)	46 (23)
Oral hypoglycemic agents and insulin	28 (13)	26 (13)
Mean A1C level*	7.3 ± 0.1	7.3 ± 0.1

Data are means ± SD or n (%), unless otherwise indicated.
*
↵* n = 293 for A1C results: 147 usual care and 146 intervention. SCID, structured clinical interview for DSM-IV.

Table 2—

Twenty-four month health care costs

	Intervention	Usual care	Difference (95% CI)
Intervention costs	$597 (560–635)	$0 (0–0)	$597 (560–635)
Median	$553	0
Antidepressant medications	$933 (794–1072)	$462 (363–560)	$471 (306–636)
Median	$805	$240
Outpatient mental health	$293 (163–422)	$342 (198–487)	−$50 (−244 to 145)
Median	$0	$0
Total mental health	$1,823 (1,614–2,032)	$804 (613–995)	$1,019 (739–1,299)
Median	$1,527	$392
Other medications	$3,245 (3,848, 3,642)	$3,516 (3,100, 3,933)	−$271 (−832 to 289)
Median	$2,782	$2,881
Other outpatient mean	$7,846 (6,951–8,740)	$8,568 (7,460–9,675)	−$722 (−2,134 to 689)
Median	$6,360	$6,821
Total outpatient	$12,913 (11,800, 14,026)	$12,888 (16,605, 14,170)	$25 (−1,638 to 1,689)
Median	$11,561	$11,381
Inpatient mental health	$10 (−9 to 29)	$52 (−50 to 154)	−$42 (−146 to 62)
Median	$0	$0
Inpatient medical costs	$5,112 (3,651–6,574)	$5,992 (3,337–8,647)	−$880 (−3,826 to 2,066)
Median	$0	$144
Grand total	$18,035 (15,948–20,123)	$18,932 (15,860–22,004)	−$896 (−4,549 to 2,755)
Median	$14,400	$14,184