Cost-effectiveness of a community-integrated home-based depression intervention in older African Americans

J Am Geriatr Soc. 2014 Dec;62(12):2288-95. doi: 10.1111/jgs.13146.

Abstract

Objectives: To test the cost-effectiveness of a home-based depression program: Beat the Blues (BTB).

Design: A cost-effectiveness analysis as part of a previously reported randomized controlled trial that compared BTB with a wait-list control group.

Setting: Community.

Participants: English-speaking, cognitively intact (Mini-Mental State Examination score ≥24), African Americans aged 55 and older with depressive symptoms (Patient Health Questionnaire score ≥5) (N = 129).

Intervention: Participants randomly assigned to BTB received up to 10 home visits over 4 months from licensed social workers who provided care management, referral and linkage, stress reduction, depression education, and behavioral activation to help participants achieve self-identified goals.

Measurements: Incremental cost-effectiveness ratios (ICERs) of BTB versus wait-list controls during the 4-month study period. The primary ICER was defined as cost per quality-adjusted life year (QALY) using the Euro Quality of Life 5D (EQ-5D) and secondarily using the Health Utilities Index-3 (HUI-3). Additional ICERs were calculated using clinical measures (cost per depression improvement, cost per depression remission). Costs included BTB intervention, depression-related healthcare visits and medications, caregiver time, and social services.

Results: BTB cost per participant per month was $146. Base case ICERs were $64,896 per QALY (EQ-5D) and $36,875 per QALY (HUI-3). Incremental cost was $2,906 per depression improvement and $3,507 per remission. Univariate and probabilistic sensitivity analyses yielded a cost/QALY range of $20,500 to $76,500.

Conclusion: Based on the range of cost-effectiveness values resulting from this study, BTB is a cost-effective treatment for managing depressive symptoms in older African Americans that compares favorably with the cost-effectiveness of previously tested approaches.

Keywords: African American; cost; cost-effectiveness; depression; health utility.

Publication types

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

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Black or African American / psychology*
  • Comorbidity
  • Cost-Benefit Analysis
  • Demography
  • Depression / therapy*
  • Female
  • Home Care Services / economics*
  • Humans
  • Male
  • Quality-Adjusted Life Years
  • Surveys and Questionnaires
  • Treatment Outcome