Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial

• Published in: JMIR mHealth and uHealth 2024-05, Vol.12, p.e55483
• Main Authors: Varela-Moreno, Esperanza, Anarte-Ortiz, Maria Teresa, Jodar-Sanchez, Francisco, Garcia-Palacios, Azucena, Monreal-Bartolomé, Alicia, Gili, Margalida, García-Campayo, Javier, Mayoral-Cleries, Fermin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical trials; Cognitive behavioral therapy; Cost analysis; Cost-Benefit Analysis - statistics & numerical data; Depression - psychology; Depression - therapy; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Female; Health care expenditures; Hemoglobin; Humans; Internet; Intervention; Male; Mental depression; Middle Aged; Patients; Primary care; Primary Health Care - economics; Primary Health Care - statistics & numerical data; Psychologists; Quality of life; Questionnaires; Sensitivity analysis; Telemedicine; Treatment Outcome
• ISSN: 2291-5222; 2291-5222
• DOI: 10.2196/55483

Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person's life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC. This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting. A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA ) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire-9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years. Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA . Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility r