Depression is one of the most common chronic mental illnesses worldwide and especially in low- and middle-income countries like India. In particular, people with type 2 diabetes are twice as likely to also suffer from depression, with the trend continuing to rise. After China, India is the country where adults have the second highest incidence of diabetes.
The Assistant Professorship of Public Health and Prevention headed by Prof. Dr. Michael Laxy took these conditions as an opportunity to evaluate, together with partners from India and the USA, the cost-effectiveness of cooperative treatment compared to usual care in adults with poorly controlled type 2 diabetes and depression in India. The results of the study were published in the journal "Diabetes Care" under the title "Cost-Effectiveness of a Collaborative Care Model Among Patients With Type 2 Diabetes and Depression in India." The journal has an impact factor of 19.112.
"Diabetes engages patients beyond the disease and often leads to psychological distress," explains Karl Emmert-Fees, Research Associate at the Assistant Professorship of Public Health and Prevention and first author of the publication. "This problem then in turn complicates the management of diabetes. So ultimately it's a never-ending cycle. That's why we wanted to test the approach of calculating the cost-effectiveness of holistic care and find out if it's ultimately worth the effort."
The data were collected between March 2015 and May 2016 as part of the "Integrating Depression and Diabetes Treatment", or INDEPENDENT, patient study conducted by the Global Diabetes Research Center at Emory University in Atlanta with Indian partners. This was conducted in four socioeconomically diverse urban diabetes clinics in India. Patients had to be at least 35 years old with a confirmed type 2 diagnosis and moderate to severe depressive symptoms. Subjects in the intervention group received holistic care for twelve months and were then followed for an additional twelve months without specific interventions. Treatment consisted of three evidence-based components at the patient level (e.g., self-management support), clinical level (e.g., electronic decision support), and system level (e.g., patient case review).
Based on this, the cost-effectiveness ratio was calculated in Indian rupees as well as international dollars. In addition, the researchers calculated the probability of cost-effectiveness using quality-adjusted life-years (QALYs) and depression-free days (DFDs). The study was funded by the National Institute of Mental Health (NIMH) in the United States.
A total of 404 patients with poorly controlled type 2 diabetes and depressive symptoms participated in the study. From the perspective of the multipayers, the average cost of the intervention group was 25,975 rupees ($1,288) higher than the control group. Total intervention costs were 309,558 rupees ($15,344) per quality-adjusted life-years (QALYs) and 228.7 rupees ($11.3) per depression-free day (DFDs).
For QALYs, the probability of the intervention being cost-effective ranged from 0.80 to 56.4 percent, using willingness-to-pay thresholds ranging from 112,000 rupees ($5,552) to 336,000 rupees ($16,654). The required willingness-to-pay per depression-free day to achieve a probability of cost-effectiveness above 95 percent was 401.6 rupees ($19.9).
Based on the results, it could be concluded that holistic care can be cost-effective over 24 months, especially when integrated into existing clinical workflows. This study can therefore serve as a model for integrating mental health and chronic disease care in other low- and middle-income countries.
"This is, of course, a research study," Prof. Laxy said. "To that extent, of course, the question now is how such an intervention would be feasible to implement in the real world, particularly in terms of the cost structure. But if it can be integrated well into everyday clinical practice, this approach is definitely worthwhile. Our very high-quality study shows a healthy relationship with regard to the cost-effectiveness of integrated care. However, precisely this integrated care has been very poorly implemented in India to date."
To the publication „Cost-Effectiveness of a Collaborative Care Model Among Patients With Type 2 Diabetes and Depression in India” in the journal „Diabetes Care”
To the homepage of the Assistant Professorship of Public Health and Prevention
Contact:
Prof. Dr. Michael Laxy
Assistant Professorship of Public Health and Prevention
Georg-Brauchle-Ring 60/62
80992 München
phone: 089 289 24977
e-mail: michael.laxy(at)tum.de
Karl Emmert-Fees
Assistant Professorship of Public Health and Prevention
Georg-Brauchle-Ring 60/62
80992 München
e-mail: karl.emmert-fees(at)tum.de
Text: Romy Schwaiger
Photos: „Diabetes Care“/Helmholtz Zentrum München/private