Abstract
Background: Treatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoana-lytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP + TAU.Methods: We conducted a within-trial economic evaluation using a Bayesian framework.Results: Quality-adjusted life years (QALYs) were 0.16 higher in the LTPP + TAU group compared with TAU. The direct cost of LTPP was 5500 pound, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP + TAU group were 5000 pound more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was approximate to 33,000 pound/QALY; the probability that LTPP + TAU was cost-effective at a willingness to pay of 20,000 pound/QALY was 18 %.Limitations: The sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50 % at all time points. The study was conducted at a single site, potentially reducing generalizability.Conclusions: Although LTPP + TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation.
Original language | English |
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Pages (from-to) | 313-321 |
Number of pages | 9 |
Journal | Journal of Affective Disorders |
Volume | 335 |
Issue number | 1 |
Early online date | 1 May 2023 |
DOIs | |
Publication status | Published - 15 Aug 2023 |
Keywords
- Randomized controlled trial
- Treatment -resistant depression
- Psychoanalytic psychotherapy
- Cost -utility analysis
- Economic evaluation
- HEALTH-CARE UTILIZATION
- PSYCHODYNAMIC THERAPY
- ANXIETY DISORDERS
- RATING-SCALE
- OUTCOMES
- BURDEN
- TRIAL