Long-term Effects on Medical Costs of Improving Depression Outcomes in Patients With Depression and Diabetes

Diabetes Care. 2008 Jun;31(6):1155-9. doi: 10.2337/dc08-0032. Epub 2008 Mar 10.


Objective: The purpose of this study was to examine the 5-year effects on total health care costs of the Pathways depression intervention program for patients with diabetes and comorbid depression compared with usual primary care.

Research design and methods: The Pathways Study was conducted in nine primary care practices of a large HMO and enrolled 329 patients with diabetes and comorbid major depression. The current study analyzed the differences in long-term medical costs between intervention and usual care patients. Participants were randomly assigned to a nurse depression intervention (n = 164) or to usual primary care (n = 165). The intervention included education about depression, behavioral activation, and a choice of either starting with support of antidepressant medication treatment by the primary care doctor or problem-solving therapy in primary care. Interventions were provided for up to 12 months, and the main outcome measures are health costs over a 5-year period.

Results: Patients in the intervention arm of the study had improved depression outcomes and trends for reduced 5-year mean total medical costs of -$3,907 (95% CI -$15,454 less to $7,640 more) compared with usual care patients. A sensitivity analysis found that these cost differences were largely explained by the patients with depression and the most severe medical comorbidity.

Conclusions: The Pathways depression collaborative care program improved depression outcomes compared with usual care with no evidence of greater long-term costs and with trends for reduced costs among the more severely medically ill patients with diabetes.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use
  • Continental Population Groups
  • Cost of Illness
  • Depressive Disorder / economics
  • Depressive Disorder / psychology*
  • Depressive Disorder / rehabilitation
  • Depressive Disorder / therapy*
  • Diabetes Complications / economics
  • Diabetes Complications / prevention & control
  • Diabetes Complications / psychology*
  • Employment
  • Female
  • Humans
  • Male
  • Marital Status
  • Middle Aged
  • Patient Education as Topic
  • Social Support
  • Surveys and Questionnaires
  • Treatment Outcome
  • Washington


  • Antidepressive Agents