000135791 001__ 135791
000135791 005__ 20240614091948.0
000135791 0247_ $$2doi$$a10.2196/55483
000135791 0248_ $$2sideral$$a138772
000135791 037__ $$aART-2024-138772
000135791 041__ $$aeng
000135791 100__ $$aVarela-Moreno, Esperanza
000135791 245__ $$aEconomic 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
000135791 260__ $$c2024
000135791 5060_ $$aAccess copy available to the general public$$fUnrestricted
000135791 5203_ $$aDepressive 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 (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.
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.
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.
000135791 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII-MECD-IISZ/FI17-00180$$9info:eu-repo/grantAgreement/ES/ISCIII-FEDER-PI19-01131
000135791 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000135791 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000135791 700__ $$aAnarte-Ortiz, Maria Teresa
000135791 700__ $$aJodar-Sanchez, Francisco
000135791 700__ $$aGarcia-Palacios, Azucena
000135791 700__ $$0(orcid)0000-0003-2088-2007$$aMonreal-Bartolomé, Alicia$$uUniversidad de Zaragoza
000135791 700__ $$aGili, Margalida
000135791 700__ $$aGarcía-Campayo, Javier
000135791 700__ $$aMayoral-Cleries, Fermin
000135791 7102_ $$14009$$2735$$aUniversidad de Zaragoza$$bDpto. Psicología y Sociología$$cÁrea Psicolog.Evolut.Educac
000135791 773__ $$g12, 15 pp. (2024), e55483$$pJMIR mHealth uHealth$$tJMIR mHealth and uHealth$$x2291-5222
000135791 8564_ $$s588664$$uhttps://zaguan.unizar.es/record/135791/files/texto_completo.pdf$$yVersión publicada
000135791 8564_ $$s2493569$$uhttps://zaguan.unizar.es/record/135791/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000135791 909CO $$ooai:zaguan.unizar.es:135791$$particulos$$pdriver
000135791 951__ $$a2024-06-14-09:00:28
000135791 980__ $$aARTICLE