Author: Jennifer Bright, MPA, Executive Director, IVI

For decades, we’ve known that untreated or poorly treated Major Depressive Disorder (MDD) is an enormous burden on individual patients, our health care system, and our society. Despite having this knowledge, there is much work to do in order to support and optimize cost-effective care for patients suffering with this burdensome illness. This work touches on every corner of our health care system: from changing our access and payment policies, to improving our delivery system and collaboration to identify the best treatment options.

The current pandemic has amplified the importance of both physical and mental wellness to the public consciousness. At the same time, we have seen an explosion of novel treatments and delivery approaches, including mobile apps and telepsychiatry. These trends reinforce the overall need for a shared understanding of what outcomes we’re trying to achieve for people living with depression. Perhaps most importantly, we need a clear definition of the factors and measures for evaluating whether both existing and emerging therapeutic interventions (drug and non-drug) for treating major depression have value. Do they achieve the desired health outcomes in a cost-effective way?

The Innovation and Value Initiative (IVI) is dedicated to exploring key questions from an inclusive perspective that takes into account more diversified input than traditional value-assessment methods. In the form of open-source models, we develop resources – to apply those methods to the challenging questions that confront those who receive, provide and pay for health care. After developing two initial prototypes addressing chronic illnesses, we now turn our attention to Major Depressive Disorder. Our ambition is to bring together stakeholders from the patient, clinician, research, industry, payer, employer, and purchaser communities to inform the design, data inputs, and uses of an open-source value assessment model addressing this disease state.

This is a unique and unprecedented approach to building a freely available and user-customizable resource that can help answer key questions such as: what sequence of interventions is most likely to be effective for subgroups of patients living with major, treatment-resistant depression? Are there factors related to patient preference that influence such optimal care? How do we compare treatment options and their cost-effectiveness to support clearer discussion between clinicians and patients about their choices? How can value assessment contribute to designing evidence-based clinical pathways that are meaningful to real-world populations?

To us, the concept of value and the dialogue about how to “know it when we see it” is a significant opportunity to improve our understanding of what clinical and quality of life outcomes matter to patients. It is also a prime opportunity to agree on the need to enhance research and transparency of resulting data for common use. In the context of Major Depressive Disorder, it’s also an opportunity to improve and accelerate the translation of evidence to practice and improve health and well-being for millions of Americans, while also increasing their confidence that we are using our scarce health care resources wisely.

We recently began this journey by inviting representatives from over a dozen organizations to collaborate in our work to create IVI’s MDD Open-Source Value Project prototype. In this way, we look forward to highlighting the relevance of patient-defined factors of value and defining the evidence and data gaps that continue to limit our ability to understand optimal care. If you’re interested in knowing more about our work, I encourage you to visit our new webpage that discusses the MDD model. On that page, you can sign up to receive updates on this groundbreaking work.