Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

Nicola S. Klein, Ben F. M. Wijnen, Joran Lokkerbol, Erik Buskens, Hermien J. Elgersma, Gerard D. van Rijsbergen, Christien Slofstra, Johan Ormel, Jack Dekker, Peter J. de Jong, Willem A. Nolen, Aart H. Schene, Steven D. Hollon, Huibert Burger, Claudi L. H. Bockting*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

Background

As depression has a recurrent course, relapse and recurrence prevention is essential.

Aims

In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT)to maintenance anti-depressants (PCT+AD)yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/-AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.

Method

Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs)as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.

Results

Mean total costs over 24 months were (sic)6814, (sic)10 264 and (sic)13 282 for AD+PCT, antidepressants only and PCT/-AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/-AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/-AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/-AD.

Conclusions

Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/-AD will become cost-effective.

Original languageEnglish
Article number12
Number of pages9
JournalBjpsych open
Volume5
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Depressive disorders
  • antidepressants
  • cognitive behavioural therapies
  • cost-effectiveness
  • economics
  • MAJOR DEPRESSIVE DISORDER
  • RECURRENT DEPRESSION
  • RELAPSE PREVENTION
  • BEHAVIORAL THERAPY
  • FOLLOW-UP
  • HEALTH
  • METAANALYSIS
  • RELAPSE/RECURRENCE
  • INTERVENTIONS
  • PREFERENCE

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