title: Cost-effectiveness of a community-integrated home-based depression intervention in older African Americans.
abstract: OBJECTIVE
  To test the cost-effectiveness of a home-based depression program: Beat the Blues (BTB).
  
  
  METHODS
  A cost-effectiveness analysis as part of a previously reported randomized controlled trial that compared BTB with a wait-list control group.
  
  
  METHODS
  Community.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Pizzi
authors.forename: Eric
authors.initials: E
authors.lastname: Jutkowitz
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Dong-Churl
authors.initials: DC
authors.lastname: Suh
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Prioli
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
mesh_terms: D000203:Activities of Daily Living; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003710:Demography; D003863:Depression / Q000628:therapy*; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: African American; cost; cost-effectiveness; depression; health utility