OBJECTIVE: Antidepressant drugs and cognitive-behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness -- Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. METHOD: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. RESULTS: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below 10,000 Australian dollars per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from 17,000 Australian dollars to 20,000 Australian dollars per DALY) but still well below 50,000 Australian dollars, which is considered the affordable threshold. CONCLUSIONS: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.
OBJECTIVE: Antidepressant drugs and cognitive-behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness -- Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. METHOD: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. RESULTS: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below 10,000 Australian dollars per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from 17,000 Australian dollars to 20,000 Australian dollars per DALY) but still well below 50,000 Australian dollars, which is considered the affordable threshold. CONCLUSIONS: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.
Authors: Shannon Wiltsey Stirman; Ana Gutiérrez-Colina; Katherine Toder; Gregory Esposito; Frances Barg; Frank Castro; Aaron T Beck; Paul Crits-Christoph Journal: Adm Policy Ment Health Date: 2013-07
Authors: Fernando Antoñanzas; Robert Terkola; Paul M Overton; Natalie Shalet; Maarten Postma Journal: Pharmacoeconomics Date: 2017-08 Impact factor: 4.981
Authors: Benjamin J R Stewart; Deborah Turnbull; Antonina A Mikocka-Walus; Hugh A J Harley; Jane M Andrews Journal: J Clin Psychol Med Settings Date: 2013-12
Authors: Paul M G Emmelkamp; Daniel David; Tom Beckers; Peter Muris; Pim Cuijpers; Wolfgang Lutz; Gerhard Andersson; Ricardo Araya; Rosa M Banos Rivera; Michael Barkham; Matthias Berking; Thomas Berger; Christina Botella; Per Carlbring; Francesc Colom; Cecilia Essau; Dirk Hermans; Stefan G Hofmann; Susanne Knappe; Thomas H Ollendick; Filip Raes; Winfried Rief; Heleen Riper; Saskia Van Der Oord; Bram Vervliet Journal: Int J Methods Psychiatr Res Date: 2014-01 Impact factor: 4.035