In-Home Cognitive Behavioral Therapy is Cost-Effective, Resulting in Fewer Days of Depression for Low-Income Mothers

Published Jan. 15, 2017
Journal of Affective Disorders

Cognitive behavioral therapy provided in the home to depressed, low-income mothers should be covered by third-party insurers and healthcare providers, not only because it is less costly than current medical standards but also because it can reduce maternal depression by 346 days over a projected three-year period.

This “bench-to-bedside” cost-effectiveness analysis, led by Robert Ammerman, PhD, ABPP, scientific director of Every Child Succeeds (ECS), shows that in-home cognitive behavioral therapy (IH-CBT) has the potential to impact both how depression is treated for  low-income mothers and how third-party payers cover it.

Researchers followed 93 depressed, low-income new mothers enrolled in ECS home-visiting programs in Southwestern Ohio and Northern Kentucky. Some received home visits only while others also received cognitive behavior therapy.

Cost-utility analysis showed that IH-CBT is more effective than home visits only and antidepressant medications. The combined approach is expected to be cost-effective more than 99.5 percent of the time across three insurer willingness-to-pay thresholds ($25,000, $50,000 and $100,000) over three years. Mothers also reported improved social support and day-to-day functioning, and lowered psychological stress.

Low-income mothers face higher-than-average risks of maternal depression, yet in many cases, they lack access to mental health resources and/or the financial ability to pay for treatment. This can leave mothers, and their children, at risk of suffering long-term consequences.

“If we’re going to make an impact on a larger scale, and if we’re going to change policy, we need data that can convince third-party payers who pay for these services,” Ammerman says. “If I were Medicaid or another third-party payer, I’d pursue this approach because it’s cost-effective.”

This model demonstrates the effectiveness of in-home cognitive behavior therapy (IH-CBT) with standard home visiting (SHV). Each dot represents one iteration of a cost-effectiveness model. A $25,000 willingness-to-pay (WTP) threshold limit line shows the number of model iterations above this threshold. The ellipse represents 95 percent of all model iterations.

Click image to enlarge.

Citation

Ammerman RT, Mallow PJ, Rizzo JA, Putnam FW, Van Ginkel JB. Cost-effectiveness of In-Home Cognitive Behavioral Therapy for low-income depressed mothers participating in early childhood prevention programs. J Affect Disord. 2017 Jan 15;208:475-482.