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Original Research
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
Shihchen Kuo, Wen Ye, Mary de Groot, Chandan Saha, Jay H. Shubrook, W. Guyton Hornsby, Yegan Pillay, Kieren J. Mather, William H. Herman
Diabetes Care 2021 Feb; dc201639. https://doi.org/10.2337/dc20-1639
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Abstract

OBJECTIVE We estimated the cost-effectiveness of the Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to usual care (UC) and each other.

RESEARCH DESIGN AND METHODS Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the health care sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained.

RESULTS From the health care sector perspective, the EXER intervention strategy saved $313 (USD) 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 with UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared with EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared with 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. In comparison with EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses.

CONCLUSIONS All three Program ACTIVE II interventions represented a good value for money compared with UC. The EXER+CBT intervention was highly cost-effective or cost saving compared with the CBT or EXER interventions.

Footnotes

  • This article contains supplementary material online at https://doi.org/10.2337/figshare.13622906.

  • Received July 1, 2020.
  • Accepted January 17, 2021.
  • © 2021 by the American Diabetes Association
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Diabetes Care: 44 (3)

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March 2021
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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
Shihchen Kuo, Wen Ye, Mary de Groot, Chandan Saha, Jay H. Shubrook, W. Guyton Hornsby, Yegan Pillay, Kieren J. Mather, William H. Herman
Diabetes Care Feb 2021, dc201639; DOI: 10.2337/dc20-1639

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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
Shihchen Kuo, Wen Ye, Mary de Groot, Chandan Saha, Jay H. Shubrook, W. Guyton Hornsby, Yegan Pillay, Kieren J. Mather, William H. Herman
Diabetes Care Feb 2021, dc201639; DOI: 10.2337/dc20-1639
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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.