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

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.