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

Laura T. Pizzi, Eric Jutkowitz, Kevin D. Frick, Dong Churl Suh, Katherine M. Prioli, Laura N. Gitlin

Research output: Contribution to journalArticlepeer-review

Abstract

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.

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.

Original languageEnglish (US)
Pages (from-to)2288-2295
Number of pages8
JournalJournal of the American Geriatrics Society
Volume62
Issue number12
DOIs
StatePublished - Dec 1 2014

Keywords

  • African American
  • cost
  • cost-effectiveness
  • depression
  • health utility

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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