Katon Wayne, Unützer Jürgen, Fan Ming-Yu, Williams John W, Schoenbaum Michael, Lin Elizabeth H B, Hunkeler Enid M
Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195-6560, USA.
Diabetes Care. 2006 Feb;29(2):265-70. doi: 10.2337/diacare.29.02.06.dc05-1572.
To determine the incremental cost-effectiveness and net benefit of a depression collaborative care program compared with usual care for patients with diabetes and depression.
This article describes a preplanned subgroup analysis of patients with diabetes from the Improving Mood-Promoting Access to Collaborative (IMPACT) randomized controlled trial. The setting for the study included 18 primary care clinics from eight health care organizations in five states. A total of 418 of 1,801 patients randomized to the IMPACT intervention (n = 204) versus usual care (n = 214) had coexisting diabetes. A depression care manager offered education, behavioral activation, and a choice of problem-solving treatment or support of antidepressant management by the primary care physician. The main outcomes were incremental cost-effectiveness and net benefit of the program compared with usual care.
Relative to usual care, intervention patients experienced 115 (95% CI 72-159) more depression-free days over 24 months. Total outpatient costs were 25 dollars (95% CI -1,638 to 1,689) higher during this same period. The incremental cost per depression-free day was 25 cents (-14 dollars to 15 dollars) and the incremental cost per quality-adjusted life year ranged from 198 dollars (144-316) to 397 dollars (287-641). An incremental net benefit of 1,129 dollars (692-1,572) was found.
The IMPACT intervention is a high-value investment for older adults with diabetes; it is associated with high clinical benefits at no greater cost than usual care.
确定与糖尿病合并抑郁症患者的常规护理相比，抑郁症协作护理项目的增量成本效益和净效益。
本文描述了对改善情绪促进协作治疗（IMPACT）随机对照试验中糖尿病患者的预先计划的亚组分析。研究地点包括来自五个州八个医疗保健组织的18家初级保健诊所。在1801名随机分配至IMPACT干预组（n = 204）与常规护理组（n = 214）的患者中，共有418名患有糖尿病。一名抑郁症护理经理提供教育、行为激活，并提供问题解决治疗选择或由初级保健医生支持抗抑郁药物管理。主要结果是该项目与常规护理相比的增量成本效益和净效益。
与常规护理相比，干预组患者在24个月内无抑郁天数多115天（95%可信区间72 - 159）。同期门诊总费用高出25美元（95%可信区间 - 1638至1689）。每无抑郁天数的增量成本为25美分（- 14美元至15美元），每质量调整生命年的增量成本在198美元（144 - 316）至397美元（287 - 641）之间。发现增量净效益为1129美元（692 - 1572）。
IMPACT干预对老年糖尿病患者是一项高价值投资；它在不高于常规护理成本的情况下带来了高临床效益。
