Cost-effectiveness of the Healthy Options group psychosocial intervention for perinatal women living with HIV and depression in Tanzania

Abstract

Healthy Options is a psychosocial support group intervention facilitated by community-based health workers (CBHWs) to reduce symptoms of depression in perinatal women living with HIV in Tanzania. The objective of this study was to determine incremental cost-effectiveness of Healthy Options intervention in comparison to enhanced usual care for depression (EUDC) intervention. This study is a cost-effectiveness analysis of Healthy Options intervention. The primary outcome for the Healthy Options intervention was level of depressive symptoms. We estimated disability adjusted life years (DALYs) by considering life years lived with disability and years of life lost due to premature mortality resulting from depression. This study applied ingredients approach to cost all resources used in the intervention. We estimated total cost, unit cost, and incremental cost-effectiveness ratio (ICER) from a health care provider perspective. We used 3-year time horizon, univariate sensitivity analysis, and adjusted costs to 2017 value. Healthy Options intervention demonstrated effectiveness in reducing depressive symptoms among pregnant women with HIV in Tanzania. Total cost of Healthy Options was $319,729. Cost per woman treated was $883. ICER at 6 weeks postpartum is $89,699 per mean decrease in depression score and $310,030 per mean decrease in depression score at 9 months. ICER per DALY averted is $24,754 at 6 months and $4,169 at 9 months. Benefits of Healthy Options are sustained through 9 months postpartum. Healthy Options is nevertheless not cost-effective because ICER is above cost-effectiveness threshold. However, since mental health care is scarce in Tanzania, working with CBHWs is likely to offer effective intervention for maternal depression among women with HIV and it can be a less costly alternative to formal mental health professionals.