Presentation (CTI)

OBJECTIVES: There is limited real world and trial based evidence on pharmacotherapy of type 2 diabetes (T2D) and depression multimorbidity. Bupropion may improve self-care adherence leading to better glycaemic outcomes in T2D with depression but has never been assessed in a randomised controlled trial (RCT). We aim to assess the cost-effectiveness of add-on bupropion in patients with T2D and depression multimorbidity.
METHODS: This crossover RCT randomly assigned (1:1) participants with T2D for ≥5 years and mild depression to receive add-on bupropion 150-mg once daily or standard care alone for three months, followed by a one-month washout period. Then, the interventions were swapped for another three months. We performed a post-hoc cost-effectiveness analysis based on drug costs and improvement in HbA1c. Drug costs were sourced from accessible pharmacies near the study site. Multiple imputation with non-parametric bootstrapping using seemingly unrelated regression was utilised to handle missing, skewed, and correlated cost and effect data, with adjustment for baseline effect.
RESULTS: 54 participants with T2D for ≥ 5 years and mild depression were studied. Add-on bupropion was associated with an incremental cost of 1293.93 [95% CI 1240.47 to 1347.39] Indian National Rupees (INR) per patient, and an incremental HbA1c improvement of 0.16% [-0.004 to 0.31]. Add-on bupropion was associated with an incremental cost-effectiveness of 8270.43 INR per unit(%) improvement in HbA1c. We performed a sensitivity analysis assuming all patients purchased generic medicines from the Jan Aushadhi centres set up by the Indian government. This led to a 73.5% reduction in ICER to 2186.91 (earlier 8270.43) INR per unit (%) improvement in HbA1c.
CONCLUSIONS: Add-on bupropion is associated with 8270.43 INR per unit (%) improvement in HbA1c in T2D with mild depression multimorbidity, with 73.5% reduction in ICER using generic drugs.