Beat the Blues

Citation: Pizzi, L., Jutkowitz, E., Frick, K., Suh, D., Prioli, K., & Gitlin, L. (2014). Cost‐Effectiveness of a Community‐Integrated Home‐Based Depression Intervention in Older African Americans. Journal of the American Geriatrics Society (JAGS), 62(12), 2288–2295. https://doi.org/10.1111/jgs.13146

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Objectives

To test the cost-effectiveness of a home-based depression program, Beat the Blues (BTB).

Design

We conducted a cost-effectiveness analysis as part of a previously reported randomized controlled trial that tested BTB versus a wait-list control group.

Setting

Community-dwelling older African American adults.

Participants

African Americans who were ≥55 years of age, English speaking, cognitively intact (MMSE ≥24), and had depressive symptoms (PHQ-9 score ≥5) (N=129).

Intervention

Participants randomly assigned to BTB received up to 10 home visits over a period of 4 months by licensed social workers who provided care management, referral/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/quality-adjusted life year using the EQ-5D and secondarily using the 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 per depression improvement was $2,906 and per remission was $3,507. Univariate and probabilistic sensitivity analyses yielded cost/QALY range of $20,500-$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.