The Health Value and Cost of Care for Major Depression

BACKGROUND: Trade-offs between costs and outcomes are a reality of health-care decisions. Cost-effectiveness analyses can guide choices toward interventions with the most health benefit for the least cost but are limited because generic measures of health value are infrequently available in the literature and are expensive to collect. OBJECTIVE: We report on the application of a new approach to estimate the health value of alternative treatment patterns. We apply this approach to common treatment patterns for major depression, and we generate estimates of the change in health value that is attributable to a particular treatment. We also obtain estimates of treatment costs and report cost/health value ratios. We used a modified expert panel approach to estimate the change in health value attributable to different patterns of treatment. We used claims and pharmacy data to define usual care treatment patterns and estimate costs. RESULTS: The lowest cost and most frequent treatment, 1 to 3 psychotherapy visits, produces minimal improvement. Treatments that include an antidepressant medication provide more health benefit per unit cost than all other treatments and adding a medication follow-up visit provides a lot of benefit for minimal cost. CONCLUSIONS: We demonstrate the application of a new approach to estimate the health value of common depression treatment practices in the United States. Our results suggest cost-effective targets for quality improvement efforts by identifying ways in which treatment for depression could cost less to get to a given outcome. Because our approach uses a generic health outcome measure, it can be applied to other conditions, permitting comparisons of benefit across diseases.