Recent evidence suggests that health status may strongly influence an individual's valuation of depression outcomes. This proposal will explore the health policy implications of obtaining depression outcome valuations for use in cost-effectiveness analyses from persons with varying levels of depression severity and the general public. This proposal is motivated by the concern that cost effectiveness analyses based on outcome valuations from persons without experience with depression may discriminate against treatments for persons with depression. The general public's continued misunderstanding of mental disorders in general and its undervaluation of depression outcomes in particular, could bias cost-effectiveness analyses (CEAs) against depression treatments (e.g. they will appear to be less cost-effective) and ultimately result in inequitable healthcare resource allocation decisions.

The specific aims are (1) examine differences in incremental depression outcome and prevention valuations across four groups: i) general population, ii) previous history of depression but not currently depressed, iii) less severe current depression, iv) more severe current depression; (2) examine the extent to which specific depression severity characteristics of the respondent (e.g. symptom severity, episode frequency, chronicity, past history of depression treatment, recent changes in depression severity, and health status) are associated with incremental depression outcome and prevention valuations; (3) examine CERs for hypothetical treatment and prevention interventions using depression outcome valuations obtained from the populations defined above and explore the health policy implications. Depression outcome valuations will be collected from 400 subjects: 100 subjects from the general population, 200 primary care patients (100 with a history of depression but not currently depressed, 75 with mild to moderate depression, and 25 with moderately severe to severe depression), and 100 mental health clinic patients (75 with moderately severe to severe depression and 25 with mild to moderate depression). We will examine two common methods for eliciting outcome valuations, rating scale and standard gamble, using an interactive computer-based program. The depression outcome descriptions will be based on the Patient Health Questionnaire (PHQ) nine-item depression module and the Medical Outcomes Study SF-12. We will also explore the equity implications of using depressed patient versus general public depression outcome and prevention valuations.

R21MH064681

2002-07-01

2006-06-30