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J Affect Disord. 2017 Jan 15;208:475-482. doi: 10.1016/j.jad.2016.10.041. Epub 2016 Nov 3.

Cost-effectiveness of In-Home Cognitive Behavioral Therapy for low-income depressed mothers participating in early childhood prevention programs.

Author information

1
Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: robert.ammerman@cchmc.org.
2
CTI Clinical Trial and Consulting, Inc., Cincinnati, OH, USA.
3
Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
4
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
5
Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

BACKGROUND:

To determine the cost-effectiveness of In-Home Cognitive Behavioral Therapy (IH-CBT) for low-income mothers enrolled in a home visiting program.

METHODS:

A cost-utility analysis was conducted using results from a clinical trial of IH-CBT and standard of care for depression derived from the literature. A probabilistic, patient-level Markov model was developed to determine Quality Adjusted Life Years (QALYs). Costs were determined using the Medical Expenditure Panel Survey. A three-year time horizon and payer perspective were used. Sensitivity analyses were employed to determine robustness of the model.

RESULTS:

IH-CBT was cost-effective relative to standard of care. IH-CBT was expected to be cost-effective at a three-year time horizon 99.5%, 99.7%, and 99.9% of the time for willingness-to-pay thresholds of US$25,000, US$50,000, and US$100,000, respectively. Patterns were upheld at one-year and five-year time horizons. Over the three-year time horizon, mothers receiving IH-CBT were expected to have 345.6 fewer days of depression relative to those receiving standard home visiting and treatment in the community.

CONCLUSIONS:

IH-CBT is a more cost-effective treatment for low-income, depressed mothers than current standards of practice. These findings add to the growing literature demonstrating the cost-effectiveness of CBT for depression, and expand it to cover new mothers. From a payer perspective, IH-CBT is a sound option for treatment of depressed, low-income mothers. Limitations include a restricted time horizon and estimating of standard of care costs.

KEYWORDS:

Cognitive-behavioral therapy; Cost-effectiveness; Major depression; Mothers

PMID:
27838144
PMCID:
PMC5154809
DOI:
10.1016/j.jad.2016.10.041
[Indexed for MEDLINE]
Free PMC Article

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