Incremental benefit-cost of MOMCare: collaborative care for perinatal depression among economically disadvantaged women
Open accessAbstract
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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These and similar elements of reengineering practice have been associated with reductions in suicide of up to 29% in clinical populations in the UK.
“These and similar elements of reengineering practice have been associated with reductions in suicide of up to 29% in clinical populations int the UK, 648”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [648]
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- Authors
- Grote, N. K., Simon, G. E., Russo, J., Lohr, M. J., Carson, K., & Katon, W.
- Affiliations
- Kaiser Permanente Washington Health Research Institute (US)
- Venue
- Psychiatric Services
- Published
- 2017-11-01
- Volume
- 68
- Issue
- 11
- Pages
- 1164-1171
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2724236706
- Cited by
- 39
- References
- 42
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 6 · 2023: 1 · 2022: 7 · 2021: 3 · 2020: 7 · 2019: 1 · 2018: 1
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- collaborative care, perinatal depression, post-traumatic stress disorder, comorbidities, Medicaid, low-income women, pregnancy, postpartum depression, pharmacotherapy, cost-effectiveness, net benefit, dysthymia
- MeSH terms
- Intersectoral Collaboration, Adult, Antidepressive Agents, Community Health Services, Cost-Benefit Analysis, Major Depressive Disorder, Female, Humans, Poverty, Pregnancy, Pregnancy Complications, Psychotherapy, Brief, Stress Disorders, Post-Traumatic, Comorbidity, Outcome Assessment, Health Care, Dysthymic Disorder, Vulnerable Populations, Young Adult
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