Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 14, 2023
Open Peer Review Period: Dec 19, 2023 - Feb 13, 2024
Date Accepted: Mar 14, 2024
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients with Type 2 Diabetes Mellitus: A Multicenter Randomized Clinical Trial
ABSTRACT
Background:
Depression and type 2 diabetes (T2DM) present a high comorbidity in Primary Care (PC) settings. Internet-delivered psychological interventions are a good alternative for care.
Objective:
To analyze the cost-effectiveness (CEA) and cost-utility (CUA) of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared to treatment as usual (TAU) in PC setting.
Methods:
A multi-center, randomized, controlled clinical trial (RCT) was conducted with 49 patients with T2DM, depressive symptoms of moderate severity and an HbA1c of 7.47% in PC settings. Patients were randomized to TAU (n = 27) or a web-based psychological treatment group (n = 22) of cognitive behavioral therapy (CBT), improvement of diabetes self-care behaviors and mindfulness. CEA for improvement of depressive symptomatology was conducted based on study based on the reduction of global severity of depressive symptomatology in a 3-, 5- and 50-percentage point reduction on the patient health questionnaire (PHQ-9). Efficacy for diabetes control was estimated based on a 0.5% percentage reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The CUA was performed based on quality-adjusted life years (QALYs).
Results:
Efficacy analysis showed that the web treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. An incremental cost-effectiveness ratio (ICER) of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for a reduction of 5 and 50 percentage points was obtained. In contrast, the ICER for improving HbA1c levels amounts to €1510.90 per participant. The incremental cost-utility ratio (ICUR) resulted in €4119.33 per QALY gained.
Conclusions:
Implementing web-based psychological interventions for people with mild/moderate depressive symptomatology and T2DM is effective and efficient compared to TAU in PC. Clinical Trial: ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709
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