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Published Online: 3 July 2017

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

Abstract

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.

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Go to Psychiatric Services
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Cover: Still Life of Fruit, anonymous, circa 1865. Gift of Edgar William and Bernice Chrysler Garbisch, National Gallery of Art, Washington, D.C.

Psychiatric Services
Pages: 1164 - 1171
PubMed: 28669288

History

Received: 8 September 2016
Revision received: 27 February 2017
Revision received: 31 March 2017
Revision received: 22 April 2017
Accepted: 4 May 2017
Published online: 3 July 2017
Published in print: November 01, 2017

Keywords

  1. Depression
  2. Cost-effectiveness analysis
  3. Brief Interpersonal Psychotherapy
  4. Posttraumatic stress disorder (PTSD)
  5. Pregnancy and mental illness

Authors

Details

Nancy K. Grote, Ph.D. [email protected]
Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle–King County Department of Public Health, Seattle, at the time of this study.
Gregory E. Simon, M.D., M.P.H.
Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle–King County Department of Public Health, Seattle, at the time of this study.
Joan Russo, Ph.D.
Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle–King County Department of Public Health, Seattle, at the time of this study.
Mary Jane Lohr, M.S.
Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle–King County Department of Public Health, Seattle, at the time of this study.
Kathy Carson, B.S.N.
Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle–King County Department of Public Health, Seattle, at the time of this study.
Wayne Katon, M.D.
Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle–King County Department of Public Health, Seattle, at the time of this study.

Notes

Send correspondence to Dr. Grote (e-mail: [email protected]).

Competing Interests

Dr. Simon reports receipt of research grants from Novartis Pharmaceuticals and Otsuka Pharmaceuticals. The other authors report no financial relationships with commercial interests.

Funding Information

National Institute of Mental Health10.13039/100000025: R01MH084897
Study support to Dr. Grote was provided by the Horizons Foundation and by grant R01MH084897 from the National Institute of Mental Health (ClinicalTrials.gov NCT01045655).

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