Cost-Effectiveness of In-Home Cognitive Behavioral Therapy for Low-Income Depressed Mothers Participating in Early Childhood Prevention Programs




Robert T. Ammerman, Peter J. Mallow, John A. Rizzo, Frank W. Putnam, and Judith B. Van Ginkel

Brief Type

Journal publication


  • Healthy Families America (HFA)
  • Nurse-Family Partnership (NFP)


Background: To determine the cost-effectiveness of In-Home Cognitive Behavioral Therapy (IH-CBT) for low-income mothers enrolled in a home visiting program. Methods: A cost-utility analysis was conducted using results from a clinical trial of IH-CBT and standard of care for depression derived from the literature. A probabilistic, patient-level Markov model was developed to determine Quality Adjusted Life Years (QALYs). Costs were determined using the Medical Expenditure Panel Survey. A three-year time horizon and payer perspective were used. Sensitivity analyses were employed to determine robustness of the model. Results: IH-CBT was cost-effective relative to standard of care. IH-CBT was expected to be cost-effective at a three-year time horizon 99.5%, 99.7%, and 99.9% of the time for willingness-to-pay thresholds of US$25,000, US$50,000, and US$100,000, respectively. Patterns were upheld at one-year and five-year time horizons. Over the three-year time horizon, mothers receiving IH-CBT were expected to have 345.6 fewer days of depression relative to those receiving standard home visiting and treatment in the community. Conclusions: IH-CBT is a more cost-effective treatment for low-income, depressed mothers than current standards of practice. These findings add to the growing literature demonstrating the cost-effectiveness of CBT for depression, and expand it to cover new mothers. From a payer perspective, IH-CBT is a sound option for treatment of depressed, low-income mothers. Limitations include a restricted time horizon and estimating of standard of care costs. (author abstract)

Data Collection Methods

  • Program administrative record reviews
  • Record and document reviews



For More Information

Ammerman, R. T., Mallow, P. J., Rizzo, J. A., Putnam, F. W., & Van Ginkel, J. B. (2017). Cost-effectiveness of in-home cognitive behavioral therapy for low-income depressed mothers participating in early childhood prevention programs. Journal of Affective Disorders, 208, 475–482. http://doi.org/10.1016/j.jad.2016.10.041
Author Contact Information:
Robert T. Ammerman


  • Cost
  • Participant, Family, and Program Outcomes