Providing
therapy for major depression to low-income
minority women is cost-effective
In
the USA, access to care for depression is poorer
for ethnic minorities than whites due to the
fact that they are less likely to be insured,
which results in greater dependence on public
health services. Several economic analyses of
clinical trials comparing depression treatments,
depression outcomes and medical costs, and the
effectiveness of quality improvement programs,
have generally shown that depression burden was
decreased following interventions. A recent
study evaluated the cost-effectiveness of
pharmacotherapy or cognitive behavior therapy
(CBT) for major depression compared with
community referral in low-income minority
women.
The clinical trial enrolled 267 women with major
depression who were randomly assigned to 1 of
the 3 treatment groups. The pharmacotherapy
group (n = 88) received paroxetine or bupropion
for up to 6 months while the CBT group (n = 90)
received 8 weekly therapy sessions which could
be extended for an additional 8 weeks. Women in
the community referral group (n = 89) were
referred to appropriate public health providers.
Hamilton Depression Rating Scale (HDRS) scores
and Medical Outcomes Study 36-Item Short-Form
Health Survey summary scores were used to assess
study patients. Intervention and health care
costs, depression-free days, and
quality-adjusted life years were the main
outcome measures. Cost-effectiveness ratios
(incremental medical cost over incremental
effectiveness) were calculated to compare the
pharmacotherapy or the CBT and the community
referral group.
The pharmacotherapy group and the CBT group had
lower mean HDRS scores from the 3rd and the 5th
month, respectively, through the 10th month.
There were more depression-free days in the
pharmacotherapy and the CBT groups than in the
community referral group. Cost-effectiveness
ratios were $24.65 for the pharmacotherapy group
and $27.04 for the CBT group, vs community
referral, per additional depression-free
day.
Pharmacotherapy and CBT were better than
community referral at alleviating depressive
symptoms in an impoverished population. However
, these depression benefits required additional
treatment resources and costs. The results of
this study indicate that providing both
interventions to low-income minority women is
cost-effective for the public health care
system. Revicki
DA, Siddique J, Frank L, Chung JY, Green BL,
Krupnick J, Prasad M, Miranda J.
Cost-effectiveness of evidence-based
pharmacotherapy or cognitive behavior therapy
compared with community referral for major
depression in predominantly low-income minority
women. Arch Gen Psychiatry 2005,
62:868-875.