Shihchen Kuo1, Wen Ye1, Mary de Groot2, Chandan Saha3, Jay H Shubrook4,5, W Guyton Hornsby6, Yegan Pillay7, Kieren J Mather3, William H Herman1. 1. University of Michigan, Ann Arbor, MI. 2. Indiana University School of Medicine, Indianapolis, IN mdegroot@iu.edu. 3. Indiana University School of Medicine, Indianapolis, IN. 4. Touro University College of Osteopathic Medicine in California, Vallejo, CA. 5. Heritage College of Osteopathic Medicine, Ohio University, Athens, OH. 6. West Virginia University School of Medicine, Morgantown, WV. 7. Ohio University, Athens, OH.
Abstract
OBJECTIVE: We estimated the cost-effectiveness of the Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to usual care (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 health care 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 health care sector perspective, the EXER intervention strategy saved $313 (USD) 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 with UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared with EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared with 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. In comparison with 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 with UC. The EXER+CBT intervention was highly cost-effective or cost saving compared with the CBT or EXER interventions.
OBJECTIVE: We estimated the cost-effectiveness of the Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to usual care (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 health care 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 health care sector perspective, the EXER intervention strategy saved $313 (USD) 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 with UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared with EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared with 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. In comparison with 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 with UC. The EXER+CBT intervention was highly cost-effective or cost saving compared with the CBT or EXER interventions.
Authors: Mary de Groot; Jay H Shubrook; W Guyton Hornsby; Yegan Pillay; Kieren J Mather; Karen Fitzpatrick; Ziyi Yang; Chandan Saha Journal: Diabetes Care Date: 2019-05-21 Impact factor: 19.112
Authors: Honghong Zhou; Deanna J M Isaman; Shari Messinger; Morton B Brown; Ronald Klein; Michael Brandle; William H Herman Journal: Diabetes Care Date: 2005-12 Impact factor: 19.112
Authors: A Nouwen; M C Adriaanse; K van Dam; M M Iversen; W Viechtbauer; M Peyrot; I Caramlau; A Kokoszka; K Kanc; M de Groot; G Nefs; F Pouwer Journal: Diabet Med Date: 2019-07-31 Impact factor: 4.359
Authors: P M Clarke; A M Gray; A Briggs; A J Farmer; P Fenn; R J Stevens; D R Matthews; I M Stratton; R R Holman Journal: Diabetologia Date: 2004-10-27 Impact factor: 10.122
Authors: Michael Brandle; Honghong Zhou; Barbara R K Smith; Deanna Marriott; Ray Burke; Bahman P Tabaei; Morton B Brown; William H Herman Journal: Diabetes Care Date: 2003-08 Impact factor: 19.112