Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women

• Published in: Psychiatric services (Washington, D.C.) Vol. 68; no. 11; pp. 1164 - 1171
• Main Authors: Grote, Nancy K, Simon, Gregory E, Russo, Joan, Lohr, Mary Jane, Carson, Kathy, Katon, Wayne
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01.11.2017; American Psychiatric Publishing, Inc
• Subjects: Adult; Antidepressive Agents - economics; Antidepressive Agents - therapeutic use; Collaboration; Community Health Services - economics; Community Health Services - methods; Comorbidity; Cost analysis; Cost-Benefit Analysis; Depressive Disorder, Major - economics; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - therapy; Dysthymic Disorder - drug therapy; Dysthymic Disorder - economics; Dysthymic Disorder - epidemiology; Dysthymic Disorder - therapy; Female; Humans; Intersectoral Collaboration; Mental depression; Mental health care; Outcome Assessment (Health Care) - economics; Post traumatic stress disorder; Poverty; Pregnancy; Pregnancy Complications - economics; Pregnancy Complications - epidemiology; Pregnancy Complications - therapy; Psychotherapy, Brief - economics; Psychotherapy, Brief - methods; Stress Disorders, Post-Traumatic - economics; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - therapy; Vulnerable Populations; Young Adult; Cost-effectiveness analysis; Depression; Brief Interpersonal Psychotherapy; Posttraumatic stress disorder (PTSD); Pregnancy and mental illness
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.201600411

Objective:Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD.Methods:A randomized trial (September 2009 to December 2014) compared the MOMCare collaborative care depression intervention (choice of brief interpersonal psychotherapy or pharmacotherapy or both) with enhanced maternity support services (MSS-Plus) in the public health system of Seattle–King County. Among pregnant women with a probable diagnosis of major depression or dysthymia (N=164), two-thirds (N=106) met criteria for probable PTSD. Blinded assessments at three, six, 12, and 18 months postbaseline included the Symptom Checklist–20 depression scale and the Cornell Services Index. Analyses of covariance estimated gain in depression free days (DFDs) by intervention and PTSD status.Results:When the analysis controlled for baseline depression severity, women with probable depression and PTSD in MOMCare had 68 more depression-free days over 18 months than those in MSS-Plus (p<.05). The additional depression care cost per MOMCare participant with comorbid PTSD was $1,312. The incremental net benefit of MOMCare was positive if a DFD was valued at ≥$20.Conclusions:For women with probable major depression and PTSD, MOMCare had significant clinical benefit over MSS-Plus, with only a moderate increase in health services cost.