Cost-effectiveness of In-Home Cognitive Behavioral Therapy for low-income depressed mothers participating in early childhood prevention programs
Cost-effectiveness of In-Home Cognitive Behavioral Therapy for low-income depressed mothers participating in early childhood prevention programs
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DOI：
10.1016/j.jad.2016.10.041
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发表时间：
2017-01-15
影响因子：
6.6
通讯作者：
Van Ginkel, Judith B.
中科院分区：
文献类型：
--
作者：
Ammerman, Robert T.;Mallow, Peter J.;Van Ginkel, Judith B.
背景：确定家庭认知行为疗法（IH-CBT）对参加家访计划的低收入母亲的成本效益。方法：采用IH-CBT临床试验的结果和文献中导出的抑郁症治疗标准进行成本-效用分析。建立了一个概率的、患者水平的马尔可夫模型来确定质量调整生命年（QALYs）。费用采用医疗支出小组调查确定。采用了三年的时间期限和付款人的观点。采用敏感性分析来确定模型的稳健性。结果：与标准治疗相比，IH-CBT具有成本效益。在支付意愿阈值分别为2.5万美元、5万美元和10万美元的情况下，预计IH-CBT在三年时间范围内的成本效益分别为99.5%、99.7%和99.9%。模式维持在一年和五年的时间范围内。在三年的时间范围内，与接受标准家访和社区治疗的母亲相比，接受IH-CBT的母亲预计抑郁天数减少345.6天。结论：对于低收入、抑郁的母亲来说，IH-CBT是一种比现行标准更具成本效益的治疗方法。这些发现增加了越来越多的文献，证明CBT治疗抑郁症的成本效益，并将其扩展到新妈妈。从付款人的角度来看，IH-CBT是治疗抑郁、低收入母亲的一个合理选择。限制包括有限的时间范围和对标准护理费用的估计。
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.