Kearns Ben, Rafia R, Leaviss J, Preston L, Brazier J E, Palmer S, Ara R
School of Health and Related Research, University of Sheffield, Sheffield, UK, S1 4DA.
Centre for Health Economics, University of York, Heslington, York, UK, YO10 5DD.
BMC Health Serv Res. 2017 Jan 24;17(1):78. doi: 10.1186/s12913-017-2003-z.
Diabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both.
A mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches.
Compared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY.
Policies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England.
糖尿病与过早死亡及多种严重并发症相关。合并抑郁症会使这些后果更易出现，并导致医疗保健成本增加。本研究的目的是评估糖尿病合并抑郁症的健康经济后果，并评估改善护理途径的潜在政策变化的成本效益：改善抑郁症的机会性筛查、抑郁症治疗的协作护理以及两者结合。
建立了一个英国2型糖尿病患者护理途径的数学模型。考虑了国民保健制度（NHS）的视角和更广泛的社会效益。证据来自通过范围界定和针对性检索确定的已发表文献。
与当前做法相比，所有三项政策都减少了抑郁症的持续时间和糖尿病相关并发症的发生数量。这些政策与生活质量的改善相关，但医疗保健成本有所增加。在增量分析中，协作护理优于改善机会性筛查。与当前做法相比，协作护理的增量成本效益比（ICER）为每质量调整生命年（QALY）10,798英镑。与协作护理相比，联合政策的ICER为每QALY 68,017英镑。
针对糖尿病患者早期识别和治疗抑郁症的政策可能会减少糖尿病相关并发症和抑郁症，进而延长预期寿命并改善与健康相关的生活质量。根据英国目前的国家指南，实施协作护理具有成本效益。
