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Randomized Controlled Trial
. 2017 Dec 29;17(1):415.
doi: 10.1186/s12888-017-1577-7.

Economic evaluation of an experience sampling method intervention in depression compared with treatment as usual using data from a randomized controlled trial

Claudia J P Simons  1   2 , Marjan Drukker  3 , Silvia Evers  4   5 , Ghislaine A P G van Mastrigt  4 , Petra Höhn  3 , Ingrid Kramer  3   6 , Frenk Peeters  3 , Philippe Delespaul  3   7 , Claudia Menne-Lothmann  3 , Jessica A Hartmann  8 , Jim van Os  3   9   10 , Marieke Wichers  11
Affiliations
Randomized Controlled Trial

Economic evaluation of an experience sampling method intervention in depression compared with treatment as usual using data from a randomized controlled trial

Claudia J P Simons et al. BMC Psychiatry. .

Abstract

Background: 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.

Methods: Participants 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).

Results: The 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.

Conclusions: We may tentatively conclude that ESM-I is a cost-effective add-on intervention to pharmacotherapy in outpatients with major depression.

Trial registration: Netherlands Trial register, NTR1974 .

Keywords: Cost-effectiveness analysis; Cost-utility analysis; Depressive disorder; Ecological momentary assessment; Experience sampling method; Intervention study; Psychological feedback.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by an institutional review board (Medical Ethics Committee of Maastricht University Medical Centre; id: NL26181.068.09 / MEC 09–3-013) and all participants provided written informed consent before their enrolment.

Consent for publication

Not applicable.

Competing interests

JvO is or has been an unrestricted research grant holder with, or has received financial compensation as an independent symposium speaker from, Eli Lilly, BMS, Lundbeck, Organon, Janssen-Cilag, GlaxoSmithKline, AstraZeneca, Pfizer, and Servier. All other authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the study. ESM = Experience Sampling Method; TAU = treatment as usual HDRS – 17-item Hamilton Depression Rating Scale; EQ-5D – EuroQol-5D-3 L; TiC-P – Trimbos/IMTA questionnaire for Costs associated with Psychiatric Illness; PRODISQ – The Productivity and Disease Questionnaire
Fig. 2
Fig. 2
Cost-effectiveness acceptability curve of the base-case analysis, assessing the Hamilton Depression Rating Scale. The analysis was controlled for baseline costs. The lines per treatment indicate the probability (y-axis), i.e., the proportion of replications this treatment has the highest net monetary benefit given various levels of willingness to pay (x-axis). At those willingness-to-pay levels where ESM-I has the higher probability compared with the other two treatments (summing up to 100%), ESM-I is the most cost-effective option. TAU = treatment as usual (control group); PSEUDO = pseudo-intervention group; ESM-I = ESM-intervention group
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve of the base-case analysis, assessing the EQ-5D. The analysis was controlled for baseline costs. The analysis was controlled for baseline costs with the bootstrapped societal costs and EQ-5D-based QALYs. The lines per treatment indicate the probability (y-axis), i.e., the proportion of replications this treatment has the highest net monetary benefit, given various levels of willingness to pay (x-axis). At those willingness-to-pay levels where ESM-I has the higher probability compared with the other two treatments (summing up to 100%), ESM-I is the most cost-effective option. At the willingness-to-pay threshold of €50,000, the probability is 46% for ESM-I, which is higher compared with TAU (20%) and Pseudo (34%). TAU = treatment as usual (control group); PSEUDO = pseudo-intervention group; ESM-I = ESM-intervention group
Fig. 4
Fig. 4
Cost-effectiveness acceptability curve of a sensitivity analysis assessing the EQ-5D: unadjusted for baseline costs
See this image and copyright information in PMC

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