title: Cost-effectiveness of In-Home Cognitive Behavioral Therapy for low-income depressed mothers participating in early childhood prevention programs.
abstract: To determine the cost-effectiveness of In-Home Cognitive Behavioral Therapy (IH-CBT) for low-income mothers enrolled in a home visiting program.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 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.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ammerman
authors.affiliation: CTI Clinical Trial and Consulting, Inc., Cincinnati, OH, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mallow
authors.affiliation: Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Putnam
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Van Ginkel
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D018479:Early Intervention, Educational; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006792:House Calls; D006801:Humans; D009035:Mothers / Q000523:psychology*; D011203:Poverty; D011247:Pregnancy; D019057:Quality-Adjusted Life Years; D055815:Young Adult
keywords: Cognitive-behavioral therapy; Cost-effectiveness; Major depression; Mothers