Cost‐Effectiveness of a Community‐Integrated Home‐Based Depression Intervention in Older African Americans. Issue 12 (December 2014)

• Record Type: Journal Article
• Authors: Pizzi, Laura T.; Jutkowitz, Eric; Frick, Kevin D.; Suh, Dong‐Churl; Prioli, Katherine M.; Gitlin, Laura N.
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 12(2014:Dec.)
• Page Start: 2288
• Page End: 2295
• Publication Date: 2014-12
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.13146
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs13146-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs13146-sec-0001" sec-type="section"> <title>Objectives</title> <p>To test the cost‐effectiveness of a home‐based depression program: Beat the Blues (BTB).</p> </sec> <sec id="jgs13146-sec-0002" sec-type="section"> <title>Design</title> <p>A cost‐effectiveness analysis as part of a previously reported randomized controlled trial that compared BTB with a wait‐list control group.</p> </sec> <sec id="jgs13146-sec-0003" sec-type="section"> <title>Setting</title> <p>Community.</p> </sec> <sec id="jgs13146-sec-0004" sec-type="section"> <title>Participants</title> <p>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).</p> </sec> <sec id="jgs13146-sec-0005" sec-type="section"> <title>Intervention</title> <p>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.</p> </sec> <sec id="jgs13146-sec-0006" sec-type="section"> <title>Measurements</title> <p>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.</p> </sec> <sec id="jgs13146-sec-0007" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="jgs13146-sec-0008" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>