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

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.

Conflict of interest statement

Conflict of Interest:

Pizzi, Frick, Suh, and Prioli have no conflicts of interest to disclose. Mr. Jutkowitz is supported by a grant from the Agency for Health Research & Quality National Research Service Award Traineeship and the Hearst Foundation. Dr. Gitlin is an employee of Johns Hopkins University and receives honoraria for various speaking engagements. Dr. Gitlin also consults with a few agencies concerning best practices with Phillips Life Line Falls Advisory Board and receives royalties for two books. The findings reported in this manuscript were funded by NIMH.

© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Figures

Figure 1

Flow Chart of Beat the Blues Trial CE Sample. No legends

Figure 2

Sensitivity Analysis 1: CE Plane and Acceptability Curve for BTB Cost per Quality-Adjusted Life Year, performed on main EQ-5D-derived ICER. aThis figure shows the costs associated with BTB for each quality-adjusted life year gained compared to the wait-list control. bCosts were assigned a gamma distribution; utilities were based on EQ-5D findings and tested with a 1-gamma distribution.

Figure 3

Sensitivity Analysis 2: Tornado Diagram Showing Impact of Changing BTB Intervention Cost Domains. aDiagram shows a one-way sensitivity analysis for the components of the BTB intervention that when varied between ± one standard deviation has the greatest impact on the main EQ-5D-derived ICER. Dollar amounts indicate the expected ICER given the low and high estimates for the four most sensitive cost domains. EV: expected value