Exercise and CBT are cost-effective for diabetes patients with depression

A study used simulation modeling to project the long-term effects of a three-month exercise and cognitive behavioral therapy (CBT) intervention for patients with type 2 diabetes and major depressive disorder. It found clear cost-effectiveness with the interventions alone or combined.


For patients with depression and type 2 diabetes, programs that provide exercise, cognitive behavioral therapy (CBT), or both are cost-effective in the long term relative to usual care, a recent study found.

Researchers used data from the Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II study and the Michigan Model for Diabetes to estimate cost and health outcomes over 10 years. Program ACTIVE, conducted in three U.S. states, randomized rural and urban adults with type 2 diabetes and major depressive disorder to three months of community-based exercise, CBT, both, or usual care. It found that either intervention resulted in significant improvement in depression and diabetes-related distress and that the combination of the two led to improved glycemic control.

The new simulation analysis, published by Diabetes Care on Feb. 19, found that the interventions, both alone and together, were cost-effective for health care systems compared with usual care. With exercise alone, there was a savings of $313 per patient and a gain of 0.38 quality-adjusted life-year (QALY). The CBT strategy cost $596 more than usual care and provided 0.29 more QALY ($2,058/QALY). The exercise plus CBT intervention cost $403 more and provided 0.69 more QALY ($585/QALY). The researchers also looked at cost-effectiveness from a societal perspective, finding that, compared to usual care, exercise saved $126 per QALY, the CBT intervention cost $2,838 per QALY, and the combination cost $1,167 per QALY. Compared to exercise alone, the combination strategy cost $3,021 per QALY.

The authors concluded that all three interventions represented a good value for money compared with usual care and that the combination of exercise and CBT was highly cost-effective or cost-saving compared to either alone. “These findings demonstrate the value for health care systems to partner with community-based fitness and mental health professionals to extend the availability of depression treatment options that are complementary to medical care for patients with type 2 diabetes in order to achieve improvements in depression and diabetes outcomes,” they wrote.