This application addresses the broad Challenge Area (05) Comparative Effectiveness Research and specific Challenge Topic, 05-MH-102*: Cost Effectiveness of Mental Health Interventions. We propose a two year initiative to add a cost and outcome component which will enable us to perform a cost effectiveness analysis of our currently funded randomized controlled trial (NIMH R01MH079814) """"""""Treating Depression in Older African Americans"""""""") that tests a novel 10- session home-based intervention to treat depression in older community-dwelling African Americans. The intervention, referred to as Beat the Blues (BTB), involves trained social workers who meet with participants to identify care management concerns, make referrals and linkages, provide depression education, develop tailored action plans to accomplish identified behavioral goals and enhance engagement in pleasurable activities, and teach stress reduction techniques for managing daily stressors (e.g., deep breathing). BTB uses a randomized two-group experimental design (treatment vs. wait-list control) in which all participants are screened twice for depressive symptoms (PHQ-9 >5) to determine study eligibility, randomly assigned, and then evaluated at 4 months on main study outcomes (PHQ-9 depression severity, quality of life, functional ability). At 4 months, the wait-list control group receives BTB in its entirety, and then all study participants are reassessed at 8 months to evaluate the maintenance of treatment effects for the treatment group, and whether the wait-list control group demonstrates similar improvements as the treatment group at 4 months. BTB is embedded in a senior center, Center in the Park (CIP) involving their agency staff as depression screeners and interventionists. Essential to translating BTB as a depression program for delivery by senior centers, is an understanding of its cost, outcomes, and cost effectiveness. Economic evaluations of home support programs for depression which target older African Americans and can be delivered by trained staff of a community-based agency are non- existent.
The specific aims of our proposed study are to: 1. Calculate the cost of delivering BTB by senior center staff trained in the program;2. Calculate the cost effectiveness of BTB from a societal perspective that employs two relevant outcome measures: cost per quality adjusted life year (QALY;Euro-QOL 5D vs. HUI2 and HU13 health utility measures), and cost per reduction in depression symptoms. Cost-effectiveness will be measured as the average incremental difference between cost of BTB and the control group divided by the difference in health utility (measured as QALYS) between treatment and control periods at 4 months, and at 8 months for the subsample of participants who receive BTB for the first 4 months and are observed for another 4 months. Univariate and probabilistic sensitivity analyses will be conducted to determine the incremental cost effectiveness of BTB at 8 months, and will aid in determining the robustness of the model when inpatient and outpatient medical and medication costs are varied. We also propose exploratory aims to: a) examine relationship between results of Euro-QOL 5D instrument (EQ-5D) and Health Utilities Index (HUI2 vs. HUI3) to inform preliminary recommendations as to which instrument is best suited for cost effectiveness in the BTB population;b) explore whether the cost effectiveness of BTB falls within established thresholds, and c) explore the application of these thresholds when applied to social-behavioral programs. This two year initiative overlaps with years 03-04 (of 5 years) of the original trial such that our proposal is feasible and can be accomplished within the structure/timeline of the parent study. The cost analyses will involve a subset (n=122/192) of participants for which we will be able to collect QALY measures. This study has potential for making a major impact on the science of economic evaluation by comparing different utility indices for their sensitivity with the target population, translational research by providing cost and cost effectiveness of a depression program for delivery by a senior center, and health policy by linking coverage decisions to adequate scientific evidence of treatment and cost effectiveness for an underserved group for whom mental health disparities persist. As the prevalence of late-life depression among older African Americans is high, an economic evaluation of BTB has great potential for improving the lives of this vulnerable population. Public Health Statement - BTB We propose an economic evaluation of a home support depression program for older African Americans elders. Our study will contribute to the science of economic evaluation by comparing utility indices for sensitivity with an older African American depressed population, translational research to enable delivery by a community organization, and health policy by linking coverage decisions to adequate scientific evidence of cost effectiveness.
- BTB We propose an economic evaluation of a home support depression program for older African Americans elders. Our study will contribute to the science of economic evaluation by comparing utility indices for sensitivity with an older African American depressed population, translational research to enable delivery by a community organization, and health policy by linking coverage decisions to adequate scientific evidence of cost effectiveness.
