Cost-effective Alternative Treatment Research Articles

Strategic combination of bacteriophages with highly susceptible cells for enhanced intestinal settlement and resistant cell killing

Avian pathogenic Escherichia coli (APEC) causes enormous economic losses and is a primary contributor to the emergence of multidrug resistance (MDR)-related problems in the poultry industry. Bacteriophage (phage) therapy has been successful in controlling MDR, but phage-resistant variants have rapidly emerged through the horizontal transmission of diverse phage defense systems carried on mobile genetic elements. Consequently, while multiple phage cocktails are recommended for phage therapy, there is a growing need to explore simpler and more cost-effective phage treatment alternatives. In this study, we characterized two novel O78-specific APEC phages, φWAO78-1 and φHAO78-1, in terms of their morphology, genome, physicochemical stability and growth kinetics. Additionally, we assessed the susceptibility of thirty-two O78 APEC strains to these phages. We analyzed the roles of highly susceptible cells in intestinal settlement and fecal shedding (susceptible cell-assisted intestinal settlement and shedding, SAIS) of phages in chickens via coinoculation with phages. Furthermore, we evaluated a new strategy, susceptible cell-assisted resistant cell killing (SARK), by comparing phage susceptibility between resistant cells alone and a mixture of resistant and highly susceptible cells in vitro. As expected, high proportions of O78 APEC strains had already acquired multiple phage defense systems, exhibiting considerable resistance to φWAO78-1 and φHAO78-1. Coinoculation of highly susceptible cells with phages prolonged phage shedding in feces, and the coexistence of susceptible cells markedly increased the phage susceptibility of resistant cells. Therefore, the SAIS and SARK strategies were demonstrated to be promising both in vivo and in vitro.

Effectiveness of 100% Tea Tree Oil (Melaleuca alternifolia) versus Salicylic Acid + Lactic Acid Solution in the Treatment of Common Warts: A Randomized Controlled Trial

Abstract Background: Common warts are a common malady among patients. Not only does it affect the person physically but also mentally and socially. Several treatment modalities are available; however, the major concerns are the treatment cost and adverse effect profile. Salicylic + lactic acid (SLA) solution is one of the standard treatment modalities owing to its strong keratolytic properties; however, its cost and adverse effects limit its use among patients. A cost-effective and safe alternative treatment is ideal to bring about a more favorable clinical outcome and better patient satisfaction. 100% tea tree oil (TTO) solution was used in this study due to its natural antiviral and anti-inflammatory properties. Objective: The study aimed to compare the safety and effectiveness of 100% TTO versus SLA solution in the treatment of common warts. Methods: A total of 17 patients with a total of 74 warts were included in the study. Each wart was assigned to either of the two treatment groups. the SLA group and the 100% TTO group. A treatment period of 6 weeks was used to assess the effectiveness of both treatment groups. Results: The study showed no significant difference between the SLA solution and 100% TTO in the treatment of common warts. The 100% tea tree group reported lesser adverse effects. Both treatment groups reported favorable treatment satisfaction. Conclusion: 100% TTO is a potentially safe and cost-effective alternative in the treatment of common warts.

Novel approach for the treatment of canine elbow hygroma with extracorporeal shockwaves.

A hygroma is a fluid filled cavity, which appears due to repetitive traumata over bony prominences. For canine elbow hygroma there is no satisfactory treatment option available. Small hygromas should not be treated at all. Larger hygromas that restrict the dog in daily life, are infected, painful, or ulcerated should be treated surgically with drainage or total excision. Surgical treatment of hygromas results in long rehabilitation times and is associated with a high complication rate. Extracorporeal shockwave therapy (ESWT) is widely used in human and veterinary rehabilitation medicine since several years. Even the mechanisms of action are not fully understood it has a wide range of indications. ESWT provides anti-inflammatory effects, promotes microcirculation, and is used for pain relief. In this case series of 4 consecutive cases in 3 dogs we treated hygromas with extracorporeal shockwaves each for 3 to 6 times usually on a weekly basis. All hygromas regressed completely and no complications were noted. Overall ESWT seems to provide a safe, easy-to-use, as well as cost-effective alternative treatment option for canine elbow hygroma.

Microbial Surfactants to the Rescue

Microbial Surfactants to the Rescue

Low-Dose Bevacizumab for the Treatment of Focal Radiation Necrosis of the Brain (fRNB): A Single-Center Case Series.

Focal radiation necrosis of the brain (fRNB) is a late adverse event that can occur following the treatment of benign or malignant brain lesions with stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS). Recent studies have shown that the incidence of fRNB is higher in cancer patients who received immune checkpoint inhibitors. The use of bevacizumab (BEV), a monoclonal antibody that targets the vascular endothelial growth factor (VEGF), is an effective treatment for fRNB when given at a dose of 5-7.5 mg/kg every two weeks. In this single-center retrospective case series, we investigated the effectiveness of a low-dose regimen of BEV (400 mg loading dose followed by 100 mg every 4 weeks) in patients diagnosed with fRNB. A total of 13 patients were included in the study; twelve of them experienced improvement in their existing clinical symptoms, and all patients had a decrease in the volume of edema on MRI scans. No clinically significant treatment-related adverse effects were observed. Our preliminary findings suggest that this fixed low-dose regimen of BEV can be a well-tolerated and cost-effective alternative treatment option for patients diagnosed with fRNB, and it is deserving of further investigation.

Clinical efficacy and safety of trimonthly administration of goserelin acetate 10.8 mg in premenopausal Chinese females with symptomatic adenomyosis: a prospective cohort study

Objective This prospective cohort study aimed to compare the clinical efficacy and safety of goserelin 10.8 mg administered trimonthly with goserelin 3.6 mg administered monthly in premenopausal females with symptomatic adenomyosis. Methods We recruited 139 premenopausal females with adenomyosis who complained of dysmenorrhea and/or menorrhagia. The first group (n = 70) received a single subcutaneous injection of goserelin 10.8 mg, and the second group (n = 69) received monthly subcutaneous goserelin 3.6 mg administered for 3 months. Follow-up was performed at the outpatient department after 12 weeks. Results Ultimately, 130 patients completed the study, including 68 and 62 patients in the goserelin 10.8 mg (n = 70) and 3.6 mg (n = 69) groups, respectively. We observed a significant decrease in the dysmenorrhea (NRS) score, uterine volume, and cancer antigen 125 (CA125) levels, and a significant increase in hemoglobin (HGB) levels in both treatment groups. There was no significant difference between the two groups. The sum of the adverse event scores was slightly higher in the goserelin 3.6 mg than in the 10.8 mg group. Conclusions The clinical efficacy of trimonthly administration of goserelin 10.8 mg was equivalent to monthly 3.6 mg dosing and was non-inferior regarding safety and tolerability. Hence, it can be a more cost-effective and convenient alternative treatment option in premenopausal females with symptomatic adenomyosis. Trial registration ChiCTR2200059548

Palliative repeated electroporations of oral tumours in dogs: A case series.

Electrochemotherapy (ECT) is a highly developed treatment for many solid tumours that provides good local control in 80% of neoplasms in dogs. ECT can be used to treat different types of tumours, particularly as an innovative approach for non-resectable masses. As reported in the literature, electroporation-based treatments are safe, simple, fast and cost-effective treatment alternatives for selected oral and maxillofacial tumours not involving the bone in dogs (e.g., small squamous cell carcinoma or malignant melanoma). In this descriptive retrospective paper, the authors describe the outcome of various types of oral tumours treated with ECT as a palliative first line treatment or as a rescue treatment in dogs with local tumour recurrence. Nineteen dogs were included and treated with at least one session of three electroporations coupled with intravenous administration of bleomycin every 21 days. Tumour size, localization, histotype, stage, recurrence, solid tumour response evaluation criteria (RECIST), local toxicity, progression free survival (PFS) and median survival time (MST) were evaluated. The small population did not allow the analysis of the ECT response by comparing different tumour types; further studies with a larger caseload are needed. However, all dogs, despite the low MST, showed a good local response to treatment with a rapid improvement in quality of life from the first ECT application; no side effects attributable to chemotherapy have been detected and toxicity due to the electroporation was minimal and well tolerated in all dogs.

Cost-Effectiveness of Pyrotinib Plus Capecitabine versus Lapatinib Plus Capecitabine for the Treatment of HER2-Positive Metastatic Breast Cancer in China: A Scenario Analysis of Health Insurance Coverage.

Background: The overexpression of the human epidermal growth factor receptor-2 (HER2) gene is present in 20~25% of breast cancer (BC) patients, contributing to an inferior prognosis. Recent clinical trials showed that pyrotinib has promising antitumor activities and acceptable tolerability for those patients (ClinicalTrials.gov, NCT03080805 and NCT02422199). Therefore, this study aims to assess the cost-effectiveness of pyrotinib plus capecitabine versus lapatinib plus capecitabine for patients with HER2-positive metastatic BC after prior trastuzumab. Methods: A lifetime-partitioned survival model was established to evaluate health and economic outcomes with different treatment strategies. The primary outcome was the incremental cost-effectiveness ratio (ICER). Data were derived from the published literature, clinical trials, expert opinions, and other local charges. Sensitivity analyses were performed to assess the robustness of the findings. Scenario analyses were developed to make further evaluations. Results: The pyrotinib regimen had significant advantages over the lapatinib regimen after enrolling in the National Reimbursement Drug List (NRDL), with cost savings of USD 15,599.27 and a gain of 0.53 QALYs. Meanwhile, before enrolling in NRDL, the pyrotinib regimen afforded the same QALYs at a higher incremental cost of USD 45,400.64 versus the lapatinib regimen, producing an ICER of USD 85,944.79 per QALY. Scenario analyses yielded similar results. Sensitivity analyses suggested stability in the cost-effectiveness findings. Conclusions: Compared to lapatinib plus capecitabine, the pyrotinib plus capecitabine enrolled in NRDL is a cost-effective alternative second-line treatment for patients with HER2-positive metastatic BC in China.

Wastewater-Fertigated Short-Rotation Coppice, a Combined Scheme of Wastewater Treatment and Biomass Production: A State-of-the-Art Review

Vegetated filters based on short-rotation coppice (SRC) can be used to treat various industrial and municipal wastewater while producing valuable biomass in an economical and sustainable way, showing potential in the field of pollution control and bio-based circular economy. This study provides an overview of the state of the art in wastewater-fertigated SRC systems (wfSRCs) worldwide. Different designs, wastewater sources, tree species and varieties, planting schemes, geographic locations, and climates for wfSRC implementation were identified after conducting a literature review. The performance review includes standard water quality parameters, BOD5, COD, nitrogen, phosphorous, and potassium, as well as the extent of pathogen and emergent contaminant removal and biomass production rates. Identified knowledge gaps and important factors to support the practical implementation of wfSRCs are highlighted. Europe leads the research of wfSRC, followed by North America and Australia. The available publications are mainly from developed countries (73%). The most applied and studied tree species in wfSRC systems are willows (32%), followed by eucalyptus (21%) and poplars (18%). Most of the reviewed studies used domestic wastewater (85%), followed by industrial wastewater (8%) and landfill leachate (7%). Most data show high BOD5 and COD removal efficiencies (80%). There are large differences in the documented total nitrogen and total phosphorus removal efficiencies (12%–99% and 40%–80%, respectively). Enhanced biomass growth in wfSRC systems due to wastewater fertigation was reported in all reviewed studies, and biomass production varied from 3.7 to 40 t DM/ha/yr. WfSRCs seem to have high potential as viable and cost-effective wastewater treatment alternatives to conventional treatment technologies.

Functional Outcome of Joshi External Stabilisation System for Proximal Humerus Fractures in Tertiary Care Centre

Background: Proximal humerus fractures account for 4-5% of all fractures. The treatment options for fractures of proximal humerus includes transosseous suture fixation, intramedullary nailing, open reduction and internal fixation using plate and percutaneous pinning. The ideal treatment of displaced proximal humeral fracture is still the centre of scientific debate. Various minimally invasive modalities have been on the rise for the past 10/15 years. This minimally invasive fixation method allows preservation of blood supply of the humeral head. The smaller K-wires used in JESS have lesser risk of soft tissue, neural, and vascular injury. Aim and Objective: To find the functional Outcome of JESS fixation for proximal humerus fracture in 33 patients. Materials and Methods: 33 patients with proximal humerus fracture were treated by JESS fixator and their functional outcome was studied. Results and Conclusion: The mean Constant Murley Score preoperatively was 29.09 which raise to 60.39 at 4 weeks post operatively, 69.97 at 8 weeks post operatively and 79.64 at 12 weeks post-operative. Thus JESS fixator is an affordable, cost effective alternative treatment option for proximal humerus fracture with minimal complications.

Economic Impact of Home-Use versus Office-Use Diphenylcyclopropenone in Extensive Alopecia Areata

Introduction: Diphenylcyclopropenone (DPCP) is the medication of choice for the treatment of severe alopecia areata (AA) according to AA treatment guidelines. Precise initiation and application are important factors for successful treatment. However, it is difficult for patients who live far away to visit their doctor weekly. Methods: We conducted a retrospective cohort study to assess the cost, effectiveness, and side effects of DPCP treatment between office-use DPCP (O-DPCP) and home-use DPCP (H-DPCP) in severe AA patients. A cost-effectiveness analysis was performed from the perspective of healthcare providers and patients using real-world data and the national cost statistics for hospital services comparing O-DPCP and H-DPCP in patients with severe AA at 24, 36, and 48 weeks. Results: Two groups of 41 patients treated with O-DPCP and H-DPCP were enrolled. There was no significant difference in the proportion of patients who showed a favorable outcome (≥50% improvement) with minimal side effects between both groups at 24 (O-DPCP 43.9% vs. H-DPCP 26.8%, p = 0.11), 36 (O-DPCP 58.5% vs. H-DPCP 43.9%, p = 0.19), or 48 weeks (O-DPCP 63.4% vs. H-DPCP 56.1%, p = 0.49). The cost of H-DPCP was half of the cost of O-DPCP. Discussion/Conclusion: H-DPCP is a cost-effective and time-efficient alternative treatment option for severe AA patients.

Cost-Effectiveness of Repository Corticotropin Injection for the Treatment of Acute Exacerbations in Multiple Sclerosis

BackgroundRelapses are common among patients with multiple sclerosis (MS) despite treatment with disease-modifying therapies. Repository corticotropin injection (RCI, Acthar® Gel), plasmapheresis (PMP), and intravenous immunoglobulin (IVIg) are alternative therapies for MS relapse. There is a dearth of economic assessments of these therapies for the acute exacerbations of MS. This study estimated the cost-effectiveness of RCI compared to PMP or IVIg.MethodsA Markov state-transition model compared outcomes (costs, relapses, remission, and utilities) with RCI versus PMP or IVIg for the acute exacerbations in MS. The model was developed from the United States (US) payer and societal perspectives over one to three years. Patients initiated on alternative therapies were evaluated in one-day increments for the first 30 days during treatment. The model assumes the natural history of MS after treatment in the first month, adjusting for the effect of treatment. Incremental cost-effectiveness ratios (ICERs) were estimated as cost per quality-adjusted life-year (QALY) gained. The uncertainty in model parameters was evaluated in probabilistic sensitivity analyses.ResultsIn the base case, RCI has an ICER of USD 42,078 per QALY compared to PMP over one year from the payer perspective and is dominant over two and three years; RCI is dominant compared to PMP from the societal perspective over all three years. Compared to IVIg, RCI is a dominant strategy from both payer and societal perspectives over all three years. Probabilistic sensitivity analysis supports the base case findings, suggesting that RCI may be cost-effective versus PMP and IVIg for acute exacerbations in MS.ConclusionRCI is a cost-effective alternative treatment for MS relapses compared to PMP and IVIg from the US payer and societal perspectives.

Markov Models for Economic Evaluation in Osteoporosis Treatment

Osteoporosis is frequent in elderly people, causing bone fractures and lowering their quality of life. The costs incurred by these fractures constitute a problem for public health. Markov chains were used to carry out an incremental cost-utility analysis of the four main drugs used in Spain to treat osteoporosis (alendronate, risedronate, denosumab and teriparatide). We considered 14 clinical transition states, from starting osteoporotic treatment at the age of 50 until death or the age of 100. Cost-effectiveness was measured by quality adjusted life years (QALYs). The values used in the Markov model were obtained from the literature. Teriparatide is the cost-effective alternative in the treatment of osteoporosis in patients with fractures from the age of 50, establishing a payment threshold of 20,000 EUR/QALY. However, it is the most expensive therapy, not appearing cost-effective in cases that do not present fracture and in ages over 80 years with fracture. Alendronate and denosumab therapies are presented as cost-effective osteoporosis treatment alternatives depending on the age of onset and duration of treatment. From the perspective of cost-effectiveness, establishing a payment threshold of 20,000 EUR/QALY, teriparatide is the cost-effective alternative in patients with fracture from the age of 50 to 70 years old in Spain.

In Vitro Comparison of the Anti-Proliferative Effects of Galenia africana on Human Skin Cell Lines

Malignant melanoma is the major cause of skin cancer-related deaths. Surgery in combination with radiotherapy, immunotherapy or chemotherapy is used to eradicate cancer cells, however, this treatment option is limited by the tolerance of the surrounding healthy tissue. The extracts from Galenia africana have been shown to possess anti-cancer flavonoid compounds and can be a safer and cost-effective alternative treatment. The study aimed to compare the anti-proliferative effects of G. africana on human skin cells (HaCaT) and human malignant melanoma cells (A375). The cells were exposed to various concentrations of the G. africana extract at different times. In vitro assays were employed to determine cell viability and cytotoxicity. Hoechst 33342 staining was performed to observe the nuclear changes, including apoptosis. G. africana significantly reduced the cell viability of the A375 cells in a dose and time-dependent manner, while having no effect on the HaCaT cells. The A375 cells displayed nuclear condensation, brightly stained nuclei and nuclear fragmentation indicative of apoptosis. This suggests a clinical rationale for the use of G. africana as a potential anti-melanoma agent offering efficacy and low toxicity. This study provides new insights for future work on investigating the utilization of G. africana in malignant melanoma treatment.

Synergistic effects of magnesium ions and simvastatin on attenuation of high-fat diet-induced bone loss

IntroductionMagnesium (Mg) has a prophylactic potential against the onset of hyperlipidemia. Similar to statin, Mg is recommended as lipid-lowering medication for hypercholesterolemia and concomitantly exhibits an association with increased bone mass. The combination of statin with Mg ions (Mg2+) may be able to alleviate the high-fat diet (HFD)-induced bone loss and reduce the side-effects of statin. This study aimed to explore the feasibility of combined Mg2+ with simvastatin (SIM) for treating HFD-induced bone loss in mice and the involving mechanisms. Materials and methodsC57BL/6 male mice were fed with a HFD or a normal-fat diet (NFD). Mice were intraperitoneally injected SIM and/or orally received water with additional Mg2+ until sacrificed. Enzyme-linked immunosorbent assay was performed to measure cytokines and cholesterol in serum and liver lysates. Bone mineral density (BMD) and microarchitecture were assessed by micro-computed tomography (μCT) in different groups. The adipogenesis in palmitate pre-treated HepG2 cells was performed under various treatments. ResultsμCT analysis showed that the trabecular bone mass was significantly lower in the HFD-fed group than that in NFD-fed group since week 8. The cortical thickness in HFD-fed group had a significant decrease at week 24, as compared with NFD-fed group. The combination of Mg2+ and SIM significantly attenuated the trabecular bone loss in HFD-fed mice via arresting the osteoclast formation and bone resorption. Besides, such combination also reduced the hepatocytic synthesis of cholesterol and inhibited matrix metallopeptidase 13 (Mmp13) mRNA expression in pre-osteoclasts. ConclusionsThe combination of Mg2+ and SIM shows a synergistic effect on attenuating the HFD-induced bone loss. Our current formulation may be a cost-effective alternative treatment to be indicated for obesity-related bone loss.

All on 4 technique assisted with computer guided surgery – A case report with 18 months follow up

The All-on-4™ technique for dental implant placement has recently generated increased interest among many patients as a highly functional, aesthetic, cost-effective treatment alternative. The technique is a good option for patients who desire fixed, natural-looking dentition, yet are not willing to undergo sinus grafting or extensive bone augmentation. Computer-guided dental implantation is a revolutionary system in dentistry. The technology offers greater accuracy and precision than do free-hand techniques, and is therefore safer. The All-on-4 method combined with guided surgery does not demand high levels of surgical expertise. Furthermore, the procedure is less traumatic for the patient—the implant is placed on the best available bone—and the technique is associated with fewer post-operative complications. We present the case of a fully edentulous patient whose maxillary and mandibular dentition was restored using a fixed prosthesis and a guided, All-on-4 technique; the patient was followed up for 18 months after surgery. Keywords: All-on-4, Computer guided surgery, Dental implants

Combo-support for a partial flangeless overlay denture in compromised circumstances - A case report

Overdenture is a favoured treatment modality for elderly patients with few remaining teeth which preclude the inevitability of “floating plastic” in edentulous mouths. Roots maintained under the denture base preserve the alveolar ridge, provide sensory feedback, retention and improve the stability of the dentures. The preservation of teeth to support an attachment-retained overdenture is an appropriate and stable alternative to extractions and complete dentures. Furthermore, the use of copings and precision attachments on the remaining teeth enhances the retention of the denture. This case report discusses a simple and cost effective alternative treatment for enhancing retention and esthetics by fabricating a flangeless tooth supported overdenture retained with different abutments such as non coping abutments and coping abutments with attachments. Keywords: Over denture, Abutments, Partial flange, Esthetics.

Combination of magnesium ions and vitamin C alleviates synovitis and osteophyte formation in osteoarthritis of mice

IntroductionWe previously demonstrated that magnesium ions (Mg2+) was a novel therapeutic alternative for osteoarthritis (OA) through promoting the hypoxia inducible factor-1α (HIF-1α)-mediated cartilage matrix synthesis. However, oxidative stress can inhibit the expression of HIF-1α, amplify the inflammation that potentially impairs the therapeutic efficacy of Mg2+ in OA. Vitamin (VC), a potent antioxidant, may enhance the efficacy of Mg2+ in OA treatment. This study aims to investigate the efficacy of combination of Mg2+ and VC on alleviating joint destruction and pain in OA. Material and methodsAnterior cruciate ligament transection with partial medial meniscectomy induced mice OA model were randomly received intra-articular injection of either saline, MgCl2 (0.5 mol/L), VC (3 mg/ml) or MgCl2 (0.5 mol/L) plus VC (3 mg/ml) at week 2 post-operation, twice weekly, for 2 weeks. Joint pain and pathological changes were assessed by gait analysis, histology, western blotting and micro-CT. ResultsMg2+ and VC showed additive effects to significantly alleviate the joint destruction and pain. The efficacy of this combined therapy could sustain for 3 months after the last injection. We demonstrated that VC enhanced the promotive effect of Mg2+ on HIF-1α expression in cartilage. Additionally, combination of Mg2+ and VC markedly promoted the M2 polarization of macrophages in synovium. Furthermore, combination of Mg2+ and VC inhibited osteophyte formation and expressions of pain-related neuropeptides. ConclusionsIntra-articular administration of Mg2+ and VC additively alleviates joint destruction and pain in OA. Our current formulation may be a cost-effective alternative treatment for OA.

Staged in situ aorto-iliac hybrid technique: an original technique to treat complex juxtarenal and iliac aneurysms.

To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone. The novel technique herein described has two main "staged" steps. The first step consists in creating an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after. The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (N.=3), two stent-grafts in iliac kissing configuration (N.=1) and to a main body of a bifurcated stent-graft (N.=1). Mean follow-up duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure. The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.

Behavioral activation with mindfulness in treating subthreshold depression in primary care: A cost-utility and cost-effectiveness analysis alongside a randomized controlled trial

This study aimed to assess the cost-utility and cost-effectiveness of group-based behavioral activation with mindfulness (BAM) versus care as usual (CAU) for treating subthreshold depression in primary care. Adults aged 18 years or older with subthreshold depression were randomized into two arms and were followed up for 12 months. BAM group was provided with eight 2-h weekly treatment by trained allied healthcare workers. CAU group could access to usual medical care but did not receive extra interventions. The health service cost in the past 12 months was self-reported by the participants. Quality-adjusted Life Years (QALYs) and clinical outcome (incidence of major depressive disorder progression) were measured. Willingness-to-pay ratio for cost-utility analysis (CUA) and cost-effectiveness analysis (CEA) was US$50,000 per QALY and US$20,000 per prevented major depression case, respectively. These ratios were used in the cost-effective acceptability curve analyses to estimate the probability of cost-effectiveness of the estimated incremental cost effectiveness ratios (ICER) of BAM versus CAU. A total of 115 and 116 participants were included in the BAM group and CAU respectively. The estimated CUA ICER was US5,979 per QALY and had a probability of 0.93 that BAM was cost-effective when compared to CAU. Furthermore, when compared to CAU, BAM was cost-effective in preventing progression of major depression: the estimated CEA ICER was US$1046 per preventable case of major progression with a probability of 0.99 to be cost-effective. Group-based BAM is considered as a cost-effective alternative treatment for treating subthreshold depression by preventing major depressive disorder.