Maria Rubio-Valera1,2,3, María Teresa Peñarrubia-María4, Maria Iglesias-González5, Martin Knapp6,7, Paul McCrone8, Marta Roig5,9, Ramón Sabes-Figuera6,10, Juan V Luciano5,11,12, Juan M Mendive11,13, Ana Gabriela Murrugara-Centurión5,11, Jordi Alonso6,14,15, Antoni Serrano-Blanco5,6. 1. Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain. mrubio@pssjd.org. 2. Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain. mrubio@pssjd.org. 3. Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. mrubio@pssjd.org. 4. Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain. 5. Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain. 6. Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain. 7. Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK. 8. Institute of Psychiatry, King's College London, De Crespigny Park, London, UK. 9. Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. 10. Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain. 11. Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. 12. Open University of Catalonia (UOC), Barcelona, Spain. 13. La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain. 14. Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. 15. Department Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
Abstract
BACKGROUND: The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild-moderate major depressive disorder. METHODS: This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners' clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost-utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. RESULTS: At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). CONCLUSIONS: Incremental cost-utility ratios favor pharmacological treatment as a first-line approach for patients with mild-moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild-moderate major depressive patients as an alternative to active monitoring in PC.
BACKGROUND: The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild-moderate major depressive disorder. METHODS: This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners' clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost-utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. RESULTS: At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). CONCLUSIONS: Incremental cost-utility ratios favor pharmacological treatment as a first-line approach for patients with mild-moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild-moderate major depressivepatients as an alternative to active monitoring in PC.
Entities:
Keywords:
Antidepressant medication; Depression/mood disorder; Health economics; Primary care
Authors: Judith E Bosmans; Marleen L M Hermens; Martine C de Bruijne; Hein P J van Hout; Berend Terluin; Lex M Bouter; Wim A B Stalman; Maurits W van Tulder Journal: J Affect Disord Date: 2008-03-14 Impact factor: 4.839