Economic Evaluation of Multi-Condition Collaborative Care Management for Depression, Diabetes and Coronary Heart Disease

Contents
Section1: Need for economic evaluation.....................................................................................................2
Section 2:.....................................................................................................................................................3
Subject of study.......................................................................................................................................3
Health technology:..............................................................................................................................3
Diseases:..............................................................................................................................................3
Type of intervention:...........................................................................................................................3
Hypothesis/study question:.................................................................................................................3
Key elements of study.............................................................................................................................4
Study population.................................................................................................................................4
Modeling and statistical exploration...................................................................................................4
Setting..................................................................................................................................................5
Dates to which data relate...................................................................................................................5
Link between effectiveness and cost data...........................................................................................5
Details about clinical evidence................................................................................................................5
Study sample.......................................................................................................................................5
Study design........................................................................................................................................6
Analysis of Effectiveness......................................................................................................................6
Effectiveness results............................................................................................................................6
Clinical conclusions:.............................................................................................................................7
Section 3:.................................................................................................................................................7
Economic analysis....................................................................................................................................7
Measure of health benefit used..........................................................................................................7
Direct costs:.........................................................................................................................................8
Productivity costs:...............................................................................................................................8
Currency:.............................................................................................................................................8
Statistical analysis of quantities/costs:................................................................................................8
Methods used to allow for uncertainty...............................................................................................9
Results.....................................................................................................................................................9
Estimated benefits used in the economic analysis..............................................................................9
Cost results..........................................................................................................................................9
Synthesis of costs and benefits..........................................................................................................10

Author’s conclusion...........................................................................................................................10
Section 4: Critical commentary..............................................................................................................10
Choice of comparator:.......................................................................................................................10
Validity of estimates of effectiveness................................................................................................11
Validity of estimate of health benefit................................................................................................12
Validity of estimate of costs..............................................................................................................12
Other issues.......................................................................................................................................13
Section 5: Future research.....................................................................................................................13

Section1: Need for economic evaluation
Effective resource management for a sustainable healthcare system and informed decisions regarding
resource allocation demands the utilization of economic considerations in the planning, decision making,
evaluation, and management of health systems (1). The economic evaluations allow the assessment of
forces of demand and supply through methods of quantitative analysis, econometric modeling, and
analytic models. These further facilitate the evaluation of complex interventions (2,3). Therefore, such
evaluations also help in informed health policy formulation and guide clinical decisions. Drawing from
the significance of economic evaluations in healthcare the evaluation study under the analysis for present
assignment focuses on the significant issues of co-morbid depression, diabetes and/or coronary heart
disease (CHD). The physiological implications of conditions such as diabetes and coronary heart disease
often pave the way to co-morbid depression (4,5). The disorders are characterized by dysregulation of the
hypothalamic-pituitary-adrenal axis, activated inflammatory responses, and the adverse impact of
functioning. Depression co-morbidity further worsens self-care and health in diabetic patients, with
additional pressure from the economic burden of diabetes (6,7).
Similarly, depression also finds a detrimental relationship with CHD prognosis, therefore the debilitating
quality of life, and costs of healthcare. The patients suffering from CHD have been indicated to acquire
subsyndromal or syndromal depression, which demands the depression management systems in place (8).
The association between the two conditions has been regarded as high, and the future predictions indicate
towards the rise of the respective association(9,10). Also, the presence or elevation of depression could, in
turn, increase the prognostic risk of recurrence of CHD and result in mortality. The chronic nature of such
conditions further contributes to complex medical regimes, conflicting medical advices, duplicative tests,
and poor adherence (11). The interventions which find implications for improvement on clinical
conditions do not necessarily exert a holistic impact on the quality of life and cost-efficacy. Therefore, in
the lieu of before mentioned health policy challenges presented by the co-morbid depression and chronic
diseases of diabetes and CHD, the present economic evaluation is necessary for assessing the economic

way for the design and administration of cost-effective interventions which improve the medical control
of the conditions with simultaneous improvement of status of quality of life.
Section 2:
Subject of study
Health technology:
The health technology utilized by the authors included the multi-condition collaborative care
management, TEAMcare intervention. The management approach comprised of a holistic combination of
principles from depression interventions, chronic care model, and integrated treat-to-target medication
strategy. The single treatment approach found application across all the three conditions of diabetes,
CHD, and depression. The healthcare provider team comprised of primary care physicians, and nurse care
manager who worked closely with both patients and PCP for effective implementation. The treatment
was compared with usual primary care administered to outpatients suffering from depression and
diabetes/CHD.
Diseases:
The study focused on the chronic illness of diabetes and Coronary Heart Disease (CHD), with co-morbid
depression.
Type of intervention:
The type of intervention was collaborative care management intervention, wherein the physician-
supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk
factors. The nurses helped the patients for the optimized systematic management of illnesses through
identification of clinical goals and development of individualized care plans. The nurses also intervened
in patient education and utilized techniques to promote the performing of self-care activities among
patients.
Hypothesis/study question:
The study aimed to answer the question that whether the interventions which improve medical disease
control and depression outcomes could also improve quality of life and cost-effectiveness of medical