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

doi:10.1192/bjo.2018.81

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 journal › Article › Academic › peer-review

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 language	English
Article number	12
Number of pages	9
Journal	Bjpsych open
Volume	5
Issue number	1
DOIs	https://doi.org/10.1192/bjo.2018.81
Publication status	Published - 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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10.1192/bjo.2018.81Licence: CC BY-NC-ND

Cite this

Klein, N. S., Wijnen, B. F. M., Lokkerbol, J., Buskens, E., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Dekker, J., de Jong, P. J., Nolen, W. A., Schene, A. H., Hollon, S. D., Burger, H., & Bockting, C. L. H. (2019). Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. Bjpsych open, 5(1), Article 12. https://doi.org/10.1192/bjo.2018.81

@article{3294d7a8097346ff937e7be9b71a7d32,

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

abstract = "BackgroundAs depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn 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.MethodData 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.ResultsMean 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.ConclusionsAdding 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.",

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",

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

note = "Funding Information: The current study was sponsored by the Netherlands Organisation for Health Research and Development (ZONMW) (171002401). In addition, C.L.H.B. worked on this manuscript during a fellowship at the Netherlands Institute for Advanced study in the Humanities and Social Sciences, supported by the Royal Netherlands Academy of Arts and Sciences. Acknowledgements Publisher Copyright: Copyright {\textcopyright} The Royal College of Psychiatrists 2019.",

year = "2019",

month = jan,

doi = "10.1192/bjo.2018.81",

language = "English",

volume = "5",

journal = "Bjpsych open",

issn = "2056-4724",

publisher = "Cambridge University Press",

number = "1",

}

Klein, NS, Wijnen, BFM, Lokkerbol, J, Buskens, E, Elgersma, HJ, van Rijsbergen, GD, Slofstra, C, Ormel, J, Dekker, J, de Jong, PJ, Nolen, WA, Schene, AH, Hollon, SD, Burger, H & Bockting, CLH 2019, 'Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants', Bjpsych open, vol. 5, no. 1, 12. https://doi.org/10.1192/bjo.2018.81

TY - JOUR

T1 - Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

AU - Klein, Nicola S.

AU - Wijnen, Ben F. M.

AU - Lokkerbol, Joran

AU - Buskens, Erik

AU - Elgersma, Hermien J.

AU - van Rijsbergen, Gerard D.

AU - Slofstra, Christien

AU - Ormel, Johan

AU - Dekker, Jack

AU - de Jong, Peter J.

AU - Nolen, Willem A.

AU - Schene, Aart H.

AU - Hollon, Steven D.

AU - Burger, Huibert

AU - Bockting, Claudi L. H.

N1 - Funding Information: The current study was sponsored by the Netherlands Organisation for Health Research and Development (ZONMW) (171002401). In addition, C.L.H.B. worked on this manuscript during a fellowship at the Netherlands Institute for Advanced study in the Humanities and Social Sciences, supported by the Royal Netherlands Academy of Arts and Sciences. Acknowledgements Publisher Copyright: Copyright © The Royal College of Psychiatrists 2019.

PY - 2019/1

Y1 - 2019/1

N2 - BackgroundAs depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn 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.MethodData 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.ResultsMean 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.ConclusionsAdding 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.

AB - BackgroundAs depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn 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.MethodData 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.ResultsMean 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.ConclusionsAdding 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.

KW - Depressive disorders

KW - antidepressants

KW - cognitive behavioural therapies

KW - cost-effectiveness

KW - economics

KW - MAJOR DEPRESSIVE DISORDER

KW - RECURRENT DEPRESSION

KW - RELAPSE PREVENTION

KW - BEHAVIORAL THERAPY

KW - FOLLOW-UP

KW - HEALTH

KW - METAANALYSIS

KW - RELAPSE/RECURRENCE

KW - INTERVENTIONS

KW - PREFERENCE

U2 - 10.1192/bjo.2018.81

DO - 10.1192/bjo.2018.81

M3 - Article

C2 - 30762507

SN - 2056-4724

VL - 5

JO - Bjpsych open

JF - Bjpsych open

IS - 1

M1 - 12

ER -