Glynn David, Saramago Pedro, Ahmed Naveed, Afaq Saima, Aslam Faiza, Basit Abdul, Ekers David, Fawwad Asher, Gibbs Naomi, Fottrell Edward, Holt Richard Ian Gregory, Jacobs Rowena, Niazi Asima Khan, Ul-Haq Zia, Zavala Gerardo A, Siddiqi Najma, Walker Simon
Centre for Research in Medical Devices (CÚRAM) and Health Economics and Policy Analysis Centre, University of Galway, Ireland, Galway, Ireland
University of York Centre for Health Economics, York, UK.
BMJ Open. 2025 May 19;15(5):e092158. doi: 10.1136/bmjopen-2024-092158.
The 'Developing and evaluating an adapted behavioural activation intervention for depression and diabetes in South Asia (DiaDeM)' trial investigates a psychological intervention, behavioural activation (BA), on people with both diabetes and depression in Bangladesh and Pakistan. This study aimed to aid the intervention and trial design.
This was a modelling study using microsimulation to assess the intervention's cost-effectiveness. Diabetes was modelled using the UK Prospective Diabetes Study model based on Pakistani patients and depression was modelled using Patient Health Questionnaire-9 (PHQ-9) trajectories allowing for multiple depressive episodes. It was assumed that diabetes-related adverse events increased depression recurrence, while depression impacted haemoglobin A1c, increasing diabetes-related events. The model estimated (1) maximum cost of BA which would be cost-effective (headroom analysis) to inform intervention design, and (2) value of reducing uncertainty around different measures (value of information analysis) to prioritise data collection in the DiaDeM study.
Analysis was conducted from a Pakistani healthcare perspective over a lifetime with costs and outcomes discounted at 3%.
BA plus usual care was compared against usual care. BA involved six sessions by a trained (non-mental health) facilitator. The usual care comparator was the prevailing mix of pharmacological and non-pharmacological treatments used in Pakistan.
The primary outcome was disability-adjusted life-years (DALYs). Secondary outcomes included life years, healthcare costs and the rate of depression and diabetes-related events.
Over their lifetime, individuals receiving BA plus usual care avoid 3.2 (95% credible interval: 2.7 to 3.8) years of mild depression and experience fewer diabetes-related events. BA plus usual care resulted in an additional 0.27 (0.03 to 0.52) life years, 0.98 (0.45 to 1.86) DALYs averted and had incremental healthcare costs of -US$97 (-US$517 to US$142), excluding BA costs. The maximum cost per BA course at which was cost-effective is US$83 (US$9 to US$214). Value of information analysis found the most important measures to include in the trial are the impact of depression on diabetes and PHQ-9 over time.
This is the first model to jointly model depression and diabetes for South Asia and uses novel methods to reflect the diseases and inform intervention and trial design. This evidence has helped to inform the design of the DiaDeM intervention and the trial to evaluate it.
DiaDeM trial: ISRCTN40885204, DOI: ; pre-results, DOI: https://doi.org/10.1186/ISRCTN40885204, DiaDeM-NIHR200806.
“在南亚开展并评估针对抑郁症和糖尿病的适应性行为激活干预（DiaDeM）”试验，旨在研究一种心理干预措施——行为激活（BA），用于治疗孟加拉国和巴基斯坦患有糖尿病和抑郁症的人群。本研究旨在辅助干预措施和试验设计。
这是一项使用微观模拟评估干预措施成本效益的建模研究。糖尿病采用基于巴基斯坦患者的英国前瞻性糖尿病研究模型进行建模，抑郁症采用患者健康问卷-9（PHQ-9）轨迹进行建模，该轨迹考虑了多次抑郁发作。假设与糖尿病相关的不良事件会增加抑郁症复发风险，而抑郁症会影响糖化血红蛋白，增加与糖尿病相关的事件。该模型估计：（1）具有成本效益的BA的最高成本（净空分析），以指导干预措施设计；（2）降低不同测量指标不确定性的价值（信息价值分析），以确定DiaDeM研究中数据收集的优先级。
从巴基斯坦医疗保健的角度进行了一生的分析，成本和结果按3%进行贴现。
将BA加常规护理与常规护理进行比较。BA由经过培训的（非心理健康）促进者进行六次疗程。常规护理对照是巴基斯坦目前使用的药物和非药物治疗的组合。
主要结局是伤残调整生命年（DALYs）。次要结局包括生命年、医疗保健成本以及抑郁症和糖尿病相关事件的发生率。
在其一生中，接受BA加常规护理的个体可避免3.2（95%可信区间：2.7至3.8）年的轻度抑郁，且经历的糖尿病相关事件较少。BA加常规护理导致额外的0.27（0.03至0.52）生命年、避免0.98（0.45至1.86）DALYs，且不包括BA成本的情况下，增加的医疗保健成本为-97美元（-517美元至142美元）。具有成本效益的每个BA疗程的最高成本为83美元（9美元至214美元）。信息价值分析发现，试验中最重要的测量指标是抑郁症随时间对糖尿病和PHQ-9 的影响。
这是首个为南亚联合建模抑郁症和糖尿病的模型，并采用新颖方法反映疾病情况，为干预措施和试验设计提供信息。该证据有助于为DiaDeM干预措施的设计以及评估该措施的试验提供信息。
DiaDeM试验：ISRCTN40885204，DOI：；预结果，DOI：https://doi.org/10.1186/ISRCTN40885204，DiaDeM-NIHR200806。
