PMH46 - Cost-Utility Analyses of Cognitive-Behavioral Therapy for Major Depressive Disorder – A Systematic Review

Abstract

Major depressive disorder (MDD) causes a massive health and economic burden for societies worldwide. Cognitive behavioural therapy (CBT) is an inherent part of the treatment of MDD and is recommended for children, adolescents and adults. Cost-Utility-Analysis (CUA) is an important instrument to support decision-making on resource allocation and health policy as it permits the comparison of interventions for different diseases. The objective of our study was to systematically review CUAs related to CBT in the treatment of patients suffering from MDD. We conducted a systematic literature search in MEDLINE, EMBASE, PsycINFO and NHSEED. We included all original studies reporting CUA of CBT for patients suffering from MDD. Cost data were inflated to the year 2011 and converted into US-$ using purchasing power parities (US-$ PPP) to ensure comparability of the data. Quality assessment of the studies was performed by means of a standardised quality checklist. We identified 22 CUAs. The methodological quality was fair. Two studies considered a lifetime horizon. The mean time horizon of the remaining studies was 19.2 months (SD = 12.6). In most instances individual and group CBT as well as CBT for maintenance showed acceptable cost-utility ratios (ICER < 50.000 US-$-PPP / QALY). The results of CUAs of CBT provided for children and adolescents or by computer were inconsistent. In comparison to medication CBT tends to be more cost effective as stand-alone therapy and in combination with medication. Individual and group CBT is a cost effective treatment for MDD. Further research to determine the cost effectiveness of computerized CBT and of CBT for specific populations like children, adolescents or the elderly is required. Furthermore there is a need for long term evidence of cost effectiveness of CBT.