Cost Effectiveness of a Home Support Program for Depression in Black Elders

描述（由申请人提供）： 此应用程序解决了广泛的挑战领域（05）比较有效性研究和特定的挑战主题，05-MH-102*：心理健康干预的成本效益。我们提出了一项为期两年的倡议，增加成本和结果的组成部分，这将使我们能够进行成本效益分析，我们目前资助的随机对照试验（NIMH R 01 MH 079814）“治疗老年非裔美国人抑郁症”），测试一种新的10届家庭为基础的干预措施，以治疗老年社区居住的非裔美国人抑郁症。干预，被称为击败蓝调（BTB），涉及训练有素的社会工作者与参与者会面，以确定护理管理问题，进行转介和联系，提供抑郁症教育，制定量身定制的行动计划，以实现确定的行为目标，并加强参与愉快的活动，并教授减压技巧，以管理日常压力源（例如，深呼吸）。BTB采用随机两组实验设计（治疗与等待列表对照），其中所有参与者都进行了两次抑郁症状（PHQ-9 >5）筛选，以确定研究资格，随机分配，然后在4个月时评估主要研究结果（PHQ-9抑郁严重程度，生活质量，功能能力）。在4个月时，等待名单对照组接受全部BTB，然后在8个月时重新评估所有研究参与者，以评估治疗组的治疗效果的维持，以及等待名单对照组是否表现出与治疗组相似的改善。BTB是嵌入在一个高级中心，中心在公园（CIP）涉及他们的机构工作人员作为抑郁症筛查和干预。将BTB转化为老年中心提供的抑郁症计划的关键是了解其成本，结果和成本效益。针对老年非裔美国人的抑郁症家庭支持计划的经济评估是不存在的，可以由社区机构的训练有素的工作人员提供。本研究的具体目的是：1.计算由经过培训的高级中心工作人员提供BTB的成本; 2.从社会角度计算BTB的成本效益，采用两个相关的结局指标：每质量调整生命年的成本（QALY; Euro-QOL 5D vs. HUI 2和HU 13健康效用指标），以及抑郁症状减少的成本。成本-效果将被测量为BTB和对照组成本之间的平均增量差异除以治疗和对照期之间的健康效用差异（测量为QOLS），在4个月和8个月时，对于前4个月接受BTB并观察另外4个月的参与者的子样本。将进行单变量和概率敏感性分析，以确定BTB在8个月时的增量成本效益，并将有助于确定住院和门诊医疗和药物费用变化时模型的稳健性。我们还提出了探索性的目的：a）检查欧洲生活质量五维量表（EQ-5D）和健康效用指数（Health Utilities Index）结果之间的关系（HUI 2 vs. HUI 3）提供关于哪种工具最适合BTB人群的成本效益的初步建议; B）探讨BTB的成本效益福尔斯是否在既定阈值范围内，以及c）探索这些阈值在应用于社会行为程序时的应用。该两年计划与原始试验的03-04年（共5年）重叠，因此我们的建议是可行的，可以在母研究的结构/时间轴内完成。成本分析将涉及一个子集（n=122/192）的参与者，我们将能够收集QALY指标。这项研究有可能对经济评估科学产生重大影响，通过比较不同的效用指数对目标人群的敏感性，通过提供老年中心提供的抑郁症计划的成本和成本效益进行转化研究，通过将保险决策与充分的治疗科学证据和成本效益联系起来，差距依然存在。由于老年非裔美国人中晚年抑郁症的患病率很高，对BTB的经济评估对改善这一弱势群体的生活具有很大的潜力。公共卫生声明- BTB我们提出了一个经济评估的家庭支持抑郁症计划的老年非洲裔美国人老人。我们的研究将有助于经济评估的科学，通过比较效用指数的敏感性与老年非裔美国人抑郁症的人口，转化研究，使交付的社区组织和卫生政策，通过连接覆盖范围的决定，以充分的科学证据的成本效益。

DESCRIPTION (provided by applicant): 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.