NEW YORK (Reuters Health) - A study in the June issue of Diabetes Care suggests that enhanced treatment of depression in diabetic patients improves their depression outcomes without an increase in long-term costs when compared with the costs of usual care.
Major depression or a depressive disorder is estimated to occur in approximately 12 percent of patients with diabetes," Dr. Wayne J. Katon, of the University of Washington School of Medicine, Seattle, and colleagues point out. Depression in these patients is associated with increases in diabetes symptoms and greater functional impairment. It is also associated with poor adherence to diabetes control mediations, proper diet and exercise, along with a tendency to begin or resume smoking.
In a clinical trial involving 329 patients with diabetes and depression, the researchers randomly assigned the subjects to the Pathways depression intervention program or to usual primary care.
Patients in the intervention group received education about depression, behavioral changes and had a choice of either starting treatment with an antidepressant medication or problem-solving therapy. The intervention support was provided for up to 12 months. The main study outcome measure was health costs over 5 years.
Compared with patients in the usual care group, those in the intervention group had improved depression outcomes and trends for reduced 5-year average total medical costs of approximately $3,900. Sensitivity analysis suggested that the greatest cost savings were for depressed patients with the most severe medical problems.
The authors note that their results are estimates and could swing in one direction or another in real-life situations -- the savings might be even greater or the costs might be higher.
For now, they advise, "Health care organizations may want to target the scarce resource of depression case management" to patients with diabetes and depression who have the highest overall level of illness.
SOURCE: Diabetes Care, June 2008.
