Abstract
BackgroundExperience sampling, a method for real-time self-monitoring of affective experiences, holds opportunities for person-tailored treatment. By focussing on dynamic patterns of positive affect, experience sampling method interventions (ESM-I) accommodate strategies to enhance personalized treatment of depression―at potentially low-costs. This study aimed to investigate the cost-effectiveness of an experience sampling method intervention in patients with depression, from a societal perspective.MethodsParticipants were recruited between January 2010 and February 2012 from out-patient mental health care facilities in or near the Dutch cities of Eindhoven and Maastricht, and through local advertisements. Out-patients diagnosed with major depression (n = 101) receiving pharmacotherapy were randomized into: (i) ESM-I consisting of six weeks of ESM combined with weekly feedback regarding the individual’s positive affective experiences, (ii) six weeks of ESM without feedback, or (iii) treatment as usual only. Alongside this randomised controlled trial, an economic evaluation was conducted consisting of a cost-effectiveness and a cost-utility analysis, using Hamilton Depression Rating Scale (HDRS) and quality adjusted life years (QALYs) as outcome, with willingness-to-pay threshold for a QALY set at €50,000 (based on Dutch guidelines for moderate severe to severe illnesses).ResultsThe economic evaluation showed that ESM-I is an optimal strategy only when willingness to pay is around €3000 per unit HDRS and around €40,500 per QALY. ESM-I was the least favourable treatment when willingness to pay was lower than €30,000 per QALY. However, at the €50,000 willingness-to-pay threshold, ESM-I was, with a 46% probability, the most favourable treatment (base-case analysis). Sensitivity analyses confirmed the robustness of these results.ConclusionsWe may tentatively conclude that ESM-I is a cost-effective add-on intervention to pharmacotherapy in outpatients with major depression.Trial registrationNetherlands Trial register, NTR1974.
Highlights
Experience sampling, a method for real-time self-monitoring of affective experiences, holds opportunities for person-tailored treatment
In the Netherlands, twelve-month prevalence of a depressive disorder is 5.2% [5], health care costs are estimated at 1592 million euros (1.8% of the total health care costs in 2011) [6], and disability days are eight times higher compared with the general population [7]
The intention-to-treat sample consisted of 101 participants (n = 33 experience sampling method (ESM)-I, n = 35 pseudo-intervention, n = 33 control group), given that one participant randomized to the pseudo-intervention did not fill in any of the assessments needed for the present analyses, not at baseline, nor at follow-up
Summary
Experience sampling, a method for real-time self-monitoring of affective experiences, holds opportunities for person-tailored treatment. By focussing on dynamic patterns of positive affect, experience sampling method interventions (ESM-I) accommodate strategies to enhance personalized treatment of depression―at potentially low-costs. This study aimed to investigate the cost-effectiveness of an experience sampling method intervention in patients with depression, from a societal perspective. Because of the high disease burden of depression [1,2,3,4,5], non-pharmacological interventions that can enhance (psychopharmacological) treatment effects have the potential to be cost-effective. Clear evidence exists for the effectiveness of combined pharmacotherapy with psychotherapy in the treatment of depression [8], face-to-face psychological treatment is cost-intensive and may, not be routinely available. Efforts to improve the efficacy of pharmacotherapy combined with psychotherapy are considered a priority
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