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
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Títol
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 TrialAutoria
Data de publicació
2024-05-16Editor
JMIR PublicationsISSN
2291-5222Cita bibliogràfica
Varela-Moreno E, Anarte-Ortiz M, Jodar-Sanchez F, Garcia-Palacios A, Monreal-Bartolomé A, Gili M, García-Campayo J, Mayoral-Cleries F 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 JMIR Mhealth Uhealth 2024;12:e55483 URL: https://mhealth.jmir.org/2024/1/e55483 DOI: 10.2196/55483Tipus de document
info:eu-repo/semantics/articleVersió
info:eu-repo/semantics/publishedVersionParaules clau / Matèries
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Resum
Background: 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 ... [+]
Background: 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.
Objective: 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.
Methods: A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of
moderate severity, and glycosylated hemoglobin (HbA1c) 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 HbA1c levels. Follow-up was performed at 3 and 6 months.
The cost-utility analysis was performed based on quality-adjusted life years.
Results: 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 HbA1c. 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 HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio
resulted in €4119.33 per quality-adjusted life year gained.
Conclusions: The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care
promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM.
Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only
benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of
including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing
personalization and adaptation for this population. [-]
Publicat a
JMIR Mhealth Uhealth 2024;12:e55483Dades relacionades
https://jmir.org/api/download?alt_name=mhealth_v12i1e55483_app1.pdf&filename=ad951192668e5ac5a93b2c075232d972.pdfEntitat finançadora
Margarita Salas postdoctoral fellowship | Universidad de Zaragoza | NextGeneration EU | Carlos III Health Institute | European Union | Institute for Health Research of Aragon
Codi del projecte o subvenció
PI19/01131 | FI17/00180
Drets d'accés
info:eu-repo/semantics/openAccess
Apareix a les col.leccions
- PSB_Articles [1321]
Except where otherwise noted, this item's license is described as ©Esperanza Varela-Moreno, Maria Teresa Anarte-Ortiz, Francisco Jodar-Sanchez, Azucena Garcia-Palacios, Alicia
Monreal-Bartolomé, Margalida Gili, Javier García-Campayo, Fermin Mayoral-Cleries. Originally published in JMIR mHealth
and uHealth (https://mhealth.jmir.org), 16.05.2024. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The
complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and
license information must be included.