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

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

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.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cognitive Behavioral Therapy / economics*
  • Cognitive Behavioral Therapy / methods*
  • Cost-Benefit Analysis
  • Depression / psychology
  • Depression / therapy*
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Early Intervention, Educational
  • Female
  • Home Care Services / economics*
  • House Calls
  • Humans
  • Mothers / psychology*
  • Poverty
  • Pregnancy
  • Quality-Adjusted Life Years
  • Young Adult