2027. A Comparison of
Depression Outcome Valuation by Depression Experience
JM Pyne, Center for Mental Healthcare and Outcomes Research, JC Fortney, Center for Mental Healthcare and Outcomes Research
Objectives: The current
recommendations for conducting cost-effectiveness (CE) analyses include using
the general public to assign value to health outcomes.
However, controversy exists about whose values to use, especially for
mental illnesses because they are not well understood by the general public.
The objective of this study was to compare the values assigned to
depression outcomes of depressed and never depressed (an approximation of the
general public) subjects. Consistent
with prospect theory, we hypothesized that the differences in the value assigned
to depression outcomes would be greater for depressed than never depressed
Methods: The study design
was cross-sectional. Each veteran
subject completed the depression outcome valuation task on the computer with a
research assistant present. Depression
outcome valuations were obtained for mild, moderate, moderately severe, and
severe depression using depression descriptions based on the PRIME MD depression
severity measure (PHQ-9). A total
of 101 subjects were recruited for the study, 52 subjects being treated for
depression from the mental health clinic and 49 subjects from the primary care
clinic with no history of depression. The
depressed subjects were divided into subthreshold and major depression based on
the total PHQ-9 score. Statistical
analyses included multiple regression and simulated
CE analyses comparing depressed and never depressed subjects.
depression outcome valuation differences between mild depression and moderate,
moderately severe, and severe depression were all greater for the subthreshold
group than the major depression and non-depressed groups (all p-values<0.05).
In the simulated CE analysis, the CE ratio using never depressed
valuations was approximately two times larger than the CE ratio using
subthreshold depressed valuations.
Conclusions: This study
provides evidence for systematic differences in depression health state
valuations based on depression experience. Subthreshold depressed subjects value
differences in depression outcomes more than major and never depressed subjects.
Impact: The efficiency of investing in depression interventions improves by 2X using subthreshold versus never depressed valuations. Future depression intervention CE analyses should include the perspective of patients who have experienced depression in order to more completely understand the value of these interventions.