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Rising mental health costs have brought with them the pressing need to identify cost-effective treatments. Identifying cost-effective treatments for depression among Latinos is particularly relevant given substantial disparities in access to depression treatment for Latinos compared to non-Latino whites.The goal of this paper is to (i) compare the cost-effectiveness of telephone and face-to-face cognitive behavioral therapy (CBT) for depression to usual care received in primary care; (ii) compare the cost-effectiveness of telephone CBT directly to face-to-face CBT.As part of a randomized trial study, primary care patients with depression were randomized into three groups: usual care, telephone CBT and face-to-face CBT. Incremental cost-effectiveness ratios (ICER) between respective groups are computed by dividing the incremental difference in mental health care costs by the incremental difference in mental health outcomes. Mental health care costs are computed as the sum of intervention costs (cost of administering sessions) and non-intervention costs (cost of mental health services used that are not part of the intervention). Prices for different types of mental health services are taken from the 2010 Medical Expenditure Panel Survey. Mental health costs are estimated using two-part models. Mental health outcomes are measured by two depression scales: Patient Health Questionnaire (PHQ-9) and Hopkins Symptom Checklist (HSCL), and are estimated using multiple linear regression models. The standard errors for ICERs are computed using 1000 bootstrapped samples and the delta method.Each CBT intervention group is significantly more costly compared to usual care in terms of mental health care costs. Face-to-face CBT patients cost USD732 more than usual care, and phone CBT patients cost USD237 more than usual care. In terms of effectiveness, both intervention groups are associated with significantly reduced (improved) scores in PHQ9 and HSCL compared to usual care. Comparing the phone therapy directly to the same treatment offered face-to-face, we find that phone CBT is significantly less costly (by USD501) and more cost-effective than face-to-face when effectiveness is measured by improvement in PHQ9 scores. Specifically, for the phone CBT group, one score reduction in PHQ9 costs USD634 less than face-to-face.One limitation is that we observe the mental health service use of patients for only four months. Phone CBT might potentially lead to substantial savings or even cost-offset in the long-run. Additional studies with long-run service use data are needed to establish these findings.The finding that phone-based intervention is able to improve the depressive symptoms of patients just as effectively as face-to-face by spending less is crucial for policy makers and health institutions looking to adopt cost-effective depression treatments.

Previous mental health care disparities studies predominantly compare mean mental health care use across racial/ethnic groups, leaving policymakers with little information on disparities among those with a higher level of expenditures.To identify racial/ethnic disparities among individuals at varying quantiles of mental health care expenditures. To assess whether disparities in the upper quantiles of expenditure differ by insurance status, income and education.Data were analyzed from a nationally representative sample of white, black and Latino adults 18 years and older (n=83,878). Our dependent variable was total mental health care expenditure. We measured disparities in any mental health care expenditures, disparities in mental health care expenditure at the 95th, 97.5 th, and 99 th expenditure quantiles of the full population using quantile regression, and at the 50 th, 75 th, and 95 th quantiles for positive users. In the full population, we tested interaction coefficients between race/ethnicity and income, insurance, and education levels to determine whether racial/ethnic disparities in the upper quantiles differed by income, insurance and education.Significant Black-white and Latino-white disparities were identified in any mental health care expenditures. In the full population, moving up the quantiles of mental health care expenditures, Black-White and Latino-White disparities were reduced but remained statistically significant. No statistically significant disparities were found in analyses of positive users only. The magnitude of black-white disparities was smaller among those enrolled in public insurance programs compared to the privately insured and uninsured in the 97.5 th and 99 th quantiles. Disparities persist in the upper quantiles among those in higher income categories and after excluding psychiatric inpatient and emergency department (ED) visits.Disparities exist in any mental health care and among those that use the most mental health care resources, but much of disparities seem to be driven by lack of access. The data do not allow us to disentangle whether disparities were related to white respondent's overuse or underuse as compared to minority groups. The cross-sectional data allow us to make only associational claims about the role of insurance, income, and education in disparities. With these limitations in mind, we identified a persistence of disparities in overall expenditures even among those in the highest income categories, after controlling for mental health status and observable sociodemographic characteristics.Interventions are needed to equalize resource allocation to racial/ethnic minority patients regardless of their income, with emphasis on outreach interventions to address the disparities in access that are responsible for the no/low expenditures for even Latinos at higher levels of illness severity.Increased policy efforts are needed to reduce the gap in health insurance for Latinos and improve outreach programs to enroll those in need into mental health care services.Future studies that conclusively disentangle overuse and appropriate use in these populations are warranted.