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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

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posted on 19.02.2021, 19:09 by Shihchen Kuo, Wen Ye, Mary de Groot, Chandan Saha, Jay H. Shubrook, W. Guyton Hornsby, Jr., Yegan Pillay, Kieren J. Mather, William H. Herman
Objective: We estimated the cost-effectiveness of the Program ACTIVE II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to 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 healthcare 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 healthcare sector perspective, the EXER intervention strategy saved $313 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 to UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to 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. Compared to 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 to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the CBT or EXER interventions.

Funding

Program ACTIVE II was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (R18DK092765 & R34DK071545). The project described was supported by Grant Number P30DK092926 (Michigan Center for Diabetes Translational Research (MCDTR), Methods and Measurement Core) from the National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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