Summary: In nonadherent Type 2 diabetic patients with comorbid depression, a secondary cost-consequence and budget impact analysis of the TELE-DD randomized trial found that a nurse-led telephone program produced more glycaemically controlled patients (HbA1c below 7 percent) and, although it cost more per controlled patient at 6 months (160.31 euros versus 49.79 euros), it cost less by 12 months (150.09 versus 179.59 euros) and 18 months (209.22 versus 376.88 euros), with an estimated first-year budget reduction of 721,940.68 euros for the funder.
PICO Summary
| Element | Detail |
|---|---|
| Population | Type 2 diabetic patients with comorbid depression who were nonadherent to pharmacological treatment; secondary economic analysis of a randomized controlled trial in primary healthcare, Spain (parent trial NCT04097483). |
| Intervention | Nurse-led telephone program (TELE-DD): structured telephone follow-up, education, and support to improve treatment adherence. |
| Comparison | Standard care without the additional nurse-led telephone follow-up. |
| Outcome | More controlled patients (HbA1c below 7 percent) in the TELE-DD group at 6, 12, and 18 months. Average cost per controlled patient: 160.31 euros versus 49.79 euros at 6 months (higher with TELE-DD), 150.09 versus 179.59 euros at 12 months, and 209.22 versus 376.88 euros at 18 months (lower with TELE-DD). Incremental cost-effectiveness ratio per additional controlled patient: 254.47 euros at 6 months, 143.65 euros at 12 months, and 177.46 euros at 18 months. Estimated first-year budget impact: a 721,940.68 euro reduction in funder expenditure. No confidence intervals, p values, or formal adherence or depression effect sizes are reported in this economic analysis. |
Expert Commentary
This report is a secondary cost-consequence and budget impact analysis layered onto an existing randomized trial, so it should be read as an economic argument rather than as fresh proof of clinical efficacy. On its own terms the verdict is favourable: although the program cost more per glycaemically controlled patient at 6 months, the cost differential reversed by 12 and 18 months, and the modelled first-year saving of roughly 722,000 euros for the funder is substantial. The central limitation is that these are derived cost metrics, not independently tested outcomes; no confidence intervals or p values accompany the figures, and the headline adherence and depression benefits belong to the parent trial, not to this analysis. Budget impact estimates are also sensitive to local salary structures, the chosen time horizon, and the assumption that trial-level control rates would be reproduced at scale, so the saving should be treated as a planning estimate rather than a guaranteed return. Can I use this with my patients? Not yet as a costed service line, but it is a reasonable basis to pilot a nurse-led telephone follow-up pathway for a clearly defined group of nonadherent Type 2 diabetic patients with depression, with local cost tracking built in. Commissioners weighing scarce nursing time would do well to fund a pragmatic local evaluation before committing to wider rollout. No industry sponsorship was declared, and the effect sizes are plausible rather than implausibly large.
References
Gomez-Barrera M, Lozano-Del Hoyo ML, Roy JF, et al. Nurse-Led Telephone Program for Nonadherent to Treatment Type 2 Diabetics With Comorbid Depression: A Cost-Consequence and Budget Impact Analysis. Journal of Nursing Management. 2024;2024:9989080. doi:10.1155/2024/9989080