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

Type of Product

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