A Supported Self-help for Recurrent Depression in Primary Care; An Economic Evaluation Alongside a Multi-center Randomised Controlled Trial

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Dec 20

PMID 30566441

Citations 2

Authors

Karolien E M Biesheuvel-Leliefeld

Judith E Bosmans

Sandra M A Dijkstra-Kersten

Filip Smit

Claudi L H Bockting

Digna J F van Schaik

Harm W J van Marwijk

Henriette E van der Horst

Affiliations

Soon will be listed here.

Abstract

Background: Major 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.

Aim: To 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.

Methods: An 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.

Results: S-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%.

Conclusions: Though 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.

Citing Articles

Economic evaluation of preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders.

de Jonge M, Blankers M, Bockting C, van Dijk M, Kikkert M, Dekker J Front Psychiatry. 2024; 14:1134071.

PMID: 38268558 PMC: 10806131. DOI: 10.3389/fpsyt.2023.1134071.

Considering the societal perspective in economic evaluations: a systematic review in the case of depression.

Duevel J, Hasemann L, Pena-Longobardo L, Rodriguez-Sanchez B, Aranda-Reneo I, Oliva-Moreno J Health Econ Rev. 2020; 10(1):32.

PMID: 32964372 PMC: 7510122. DOI: 10.1186/s13561-020-00288-7.

References

Conradi H, Ormel J, de Jonge P . Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med. 2010; 41(6):1165-74. DOI: 10.1017/S0033291710001911. View

Vos T, Flaxman A, Naghavi M, Lozano R, Michaud C, Ezzati M . Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2163-96. PMC: 6350784. DOI: 10.1016/S0140-6736(12)61729-2. View

Biesheuvel-Leliefeld K, Dijkstra-Kersten S, van Schaik D, van Marwijk H, Smit F, van der Horst H . Effectiveness of Supported Self-Help in Recurrent Depression: A Randomized Controlled Trial in Primary Care. Psychother Psychosom. 2017; 86(4):220-230. DOI: 10.1159/000472260. View

Nierenberg A, Husain M, Trivedi M, Fava M, Warden D, Wisniewski S . Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report. Psychol Med. 2009; 40(1):41-50. PMC: 5886713. DOI: 10.1017/S0033291709006011. View

Greenberg P, Kessler R, Birnbaum H, Leong S, Lowe S, Berglund P . The economic burden of depression in the United States: how did it change between 1990 and 2000?. J Clin Psychiatry. 2004; 64(12):1465-75. DOI: 10.4088/jcp.v64n1211. View

Brooks R . EuroQol: the current state of play. Health Policy. 1996; 37(1):53-72. DOI: 10.1016/0168-8510(96)00822-6. View

Burcusa S, Iacono W . Risk for recurrence in depression. Clin Psychol Rev. 2007; 27(8):959-85. PMC: 2169519. DOI: 10.1016/j.cpr.2007.02.005. View

Spek V, Cuijpers P, Nyklicek I, Smits N, Riper H, Keyzer J . One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years. Psychol Med. 2008; 38(5):635-9. DOI: 10.1017/S0033291707002590. View

Fenwick E, OBrien B, Briggs A . Cost-effectiveness acceptability curves--facts, fallacies and frequently asked questions. Health Econ. 2004; 13(5):405-15. DOI: 10.1002/hec.903. View

10.

Egede L . Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007; 29(5):409-16. DOI: 10.1016/j.genhosppsych.2007.06.002. View

11.

Willan A, Briggs A, Hoch J . Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ. 2004; 13(5):461-75. DOI: 10.1002/hec.843. View

12.

Smit F, Willemse G, Koopmanschap M, Onrust S, Cuijpers P, Beekman A . Cost-effectiveness of preventing depression in primary care patients: randomised trial. Br J Psychiatry. 2006; 188:330-6. DOI: 10.1192/bjp.188.4.330. View

13.

Bockting C, Schene A, Spinhoven P, Koeter M, Wouters L, Huyser J . Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. J Consult Clin Psychol. 2005; 73(4):647-57. DOI: 10.1037/0022-006X.73.4.647. View

14.

Lynch F, Hornbrook M, Clarke G, Perrin N, Polen M, OConnor E . Cost-effectiveness of an intervention to prevent depression in at-risk teens. Arch Gen Psychiatry. 2005; 62(11):1241-8. DOI: 10.1001/archpsyc.62.11.1241. View

15.

Fava M, Graves L, Benazzi F, Scalia M, Iosifescu D, Alpert J . A cross-sectional study of the prevalence of cognitive and physical symptoms during long-term antidepressant treatment. J Clin Psychiatry. 2007; 67(11):1754-9. DOI: 10.4088/jcp.v67n1113. View

16.

Greenberg P, Birnbaum H . The economic burden of depression in the US: societal and patient perspectives. Expert Opin Pharmacother. 2005; 6(3):369-76. DOI: 10.1517/14656566.6.3.369. View

17.

Simon G, Von Korff M, Ludman E, Katon W, Rutter C, Unutzer J . Cost-effectiveness of a program to prevent depression relapse in primary care. Med Care. 2002; 40(10):941-50. DOI: 10.1097/00005650-200210000-00011. View

18.

White I, Royston P, Wood A . Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011; 30(4):377-99. DOI: 10.1002/sim.4067. View

19.

Beshai S, Dobson K, Bockting C, Quigley L . Relapse and recurrence prevention in depression: current research and future prospects. Clin Psychol Rev. 2011; 31(8):1349-60. DOI: 10.1016/j.cpr.2011.09.003. View

20.

Wells K, Stewart A, Hays R, Burnam M, Rogers W, Daniels M . The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989; 262(7):914-9. View