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 subjects.

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.

Results:  The 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.