| dc.contributor.author | Hollon, Steven D. | |
| dc.date.accessioned | 2020-10-22T17:19:55Z | |
| dc.date.available | 2020-10-22T17:19:55Z | |
| dc.date.issued | 2019-01 | |
| dc.identifier.citation | Klein, N. S., Wijnen, B., Lokkerbol, J., Buskens, E., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Dekker, J., de Jong, P. J., Nolen, W. A., Schene, A. H., Hollon, S. D., Burger, H., & Bockting, C. (2019). Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. BJPsych open, 5(1), e12. https://doi.org/10.1192/bjo.2018.81 | en_US |
| dc.identifier.issn | 2056-4724 | |
| dc.identifier.uri | http://hdl.handle.net/1803/16245 | |
| dc.description | Only Vanderbilt University affiliated authors are listed on VUIR. For a full list of authors, access the version of record at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381417/ | en_US |
| dc.description.abstract | Background
As depression has a recurrent course, relapse and recurrence prevention is essential.
Aims
In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT)to maintenance anti-depressants (PCT+AD)yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/-AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.
Method
Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs)as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.
Results
Mean total costs over 24 months were (sic)6814, (sic)10 264 and (sic)13 282 for AD+PCT, antidepressants only and PCT/-AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/-AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/-AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/-AD.
Conclusions
Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/-AD will become cost-effective. | en_US |
| dc.description.sponsorship | The current study was sponsored by the Netherlands Organisation for Health Research and Development (ZONMW) (171002401). In addition, C.L.H.B. worked on this manuscript during a fellowship at the Netherlands Institute for Advanced study in the Humanities and Social Sciences, supported by the Royal Netherlands Academy of Arts and Sciences. | en_US |
| dc.language.iso | en_US | en_US |
| dc.publisher | BJPsych Open | en_US |
| dc.rights | Copyright © The Royal College of Psychiatrists 2019
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work. | |
| dc.source.uri | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381417/ | |
| dc.subject | Depressive disorders | en_US |
| dc.subject | antidepressants | en_US |
| dc.subject | cognitive behavioural therapies | en_US |
| dc.subject | cost-effectiveness | en_US |
| dc.subject | economics | en_US |
| dc.title | Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants | en_US |
| dc.type | Article | en_US |
| dc.identifier.doi | 10.1192/bjo.2018.81 | |
