Cost-Effectiveness of a Collaborative Care Model Among Patients With Type 2 Diabetes and Depression in India

Author:

Emmert-Fees Karl M.F.12345ORCID,Laxy Michael1235,Patel Shivani A.3,Singh Kavita6,Poongothai Subramani7,Mohan Viswanathan7,Chwastiak Lydia8,Narayan K.M. Venkat3,Sagar Rajesh9,Sosale Aravind R.10,Anjana Ranjit Mohan7,Sridhar Gumpeny R.11,Tandon Nikhil12,Ali Mohammed K.313

Affiliation:

1. 1Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany

2. 2German Center for Diabetes Research (DZD), Neuherberg, Germany

3. 3Hubert Department of Global Health, Emory University, Atlanta, GA

4. 4Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany

5. 5Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany

6. 6Centre for Chronic Conditions and Injuries, Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India

7. 7Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India

8. 8Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

9. 9Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India

10. 10Diabetes Care and Research Center, DIACON Hospital, Bangalore, Karnataka, India

11. 11Endocrine and Diabetes Centre, Visakhapatnam, India

12. 12Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi

13. 13Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States

Abstract

OBJECTIVE To assess the cost-effectiveness of collaborative versus usual care in adults with poorly controlled type 2 diabetes and depression in India. RESEARCH DESIGN AND METHODS We performed a within-trial cost-effectiveness analysis of a 24-month parallel, open-label, pragmatic randomized clinical trial at four urban clinics in India from multipayer and societal perspectives. The trial randomly assigned 404 patients with poorly controlled type 2 diabetes (HbA1c ≥8.0%, systolic blood pressure ≥140 mmHg, or LDL cholesterol ≥130 mg/dL) and depressive symptoms (9-item Patient Health Questionnaire score ≥10) to collaborative care (support from nonphysician care coordinators, electronic registers, and specialist-supported case review) for 12 months, followed by 12 months of usual care or 24 months of usual care. We calculated incremental cost-effectiveness ratios (ICERs) in Indian rupees (INR) and international dollars (Int’l-$) and the probability of cost-effectiveness using quality-adjusted life-years (QALYs) and depression-free days (DFDs). RESULTS From a multipayer perspective, collaborative care costed an additional INR309,558 (Int’l-$15,344) per QALY and an additional INR290.2 (Int’l-$14.4) per DFD gained compared with usual care. The probability of cost-effectiveness was 56.4% using a willingness to pay of INR336,000 (Int’l-$16,654) per QALY (approximately three times per-capita gross domestic product). The willingness to pay per DFD to achieve a probability of cost-effectiveness >95% was INR401.6 (Int’l-$19.9). From a societal perspective, cost-effectiveness was marginally lower. In sensitivity analyses, integrating collaborative care in clinical workflows reduced incremental costs by ∼47% (ICER 162,689 per QALY, cost-effectiveness probability 89.4%), but cost-effectiveness decreased when adjusting for baseline values. CONCLUSIONS Collaborative care for patients with type 2 diabetes and depression in urban India can be cost-effective, especially when integrated in clinical workflows. Long-term cost-effectiveness might be more favorable. Scalability across lower- and middle-income country settings depends on heterogeneous contextual factors.

Funder

National Institute of Mental Health

National Institutes of Mental Health

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference45 articles.

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