Abstract
BackgroundMajor depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care.AimTo evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission.MethodsAn economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs.ResultsS-PCT statistically significantly decreased relapse or recurrence by 15% (95%CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95%CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80%. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21%.ConclusionsThough ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU.
Highlights
Major depressive disorder (MDD) is a prevalent mental disorder that often runs an intermittent lifelong course[1], is associated with a high risk of relapse or recurrence[2] and with frequently incomplete remission between episodes[3,4,5]
The cost-effectiveness analysis (CEA) curve indicated that at a Willingness To Pay (WTP) of 30,000 €/QALY gained, the probability that Self-help Preventive Cognitive Therapy (S-PCT) is cost-effective compared to TAU is 21%
Though depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU
Summary
Major depressive disorder (MDD) is a prevalent mental disorder that often runs an intermittent lifelong course[1], is associated with a high risk of relapse or recurrence[2] and with frequently incomplete remission between episodes[3,4,5]. Important factors contributing to the considerable healthcare costs associated with depression are the high prevalence, early age of onset and large risk of relapse or recurrence. Effective preventive interventions may be beneficial from the viewpoint of patients and society [19,20]. Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care
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