Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

Affiliations

¹ PhD Candidate,Department of Clinical Psychology and Experimental Psychopathology,University of Groningen;and Psychologist, Top Referent Traumacentrum,GGZ Drenthe,the Netherlands.
² Health Economist,Center of Economic Evaluation,Trimbos Institute (Netherlands Institute of Mental Health and Addiction);and Postdoctoral Researcher,Department of Health Services Research,Maastricht University,Care and Public Health Research Institute CAPHRI,the Netherlands.
³ Director, Center of Economic Evaluation,Trimbos Institute (Netherlands Institute of Mental Health and Addiction),the Netherlands;and Harkness Fellow in Health Care Policy and Practice,Department of Health Care Policy,Harvard Medical School,USA.
⁴ Professor of Health Technology Assessment,Faculty of Economics and Business,University Medical Center Groningen, University of Groningen,the Netherlands.
⁵ PhD Candidate,Department of Clinical Psychology and Experimental Psychopathology,University of Groningen;and Clinical Psychologist,Accare,the Netherlands.
⁶ Health Care Psychologist,Department of Early Detection and Intervention in Psychosis,GGZ Drenthe,the Netherlands.
⁷ Senior Researcher,Lentis Psychiatric Institute,Lentis Research,the Netherlands.
⁸ Professor of Psychiatric Epidemiology,University Center for Psychiatry and Interdisciplinary Center Psychiatric Epidemiology,University of Groningen, University Medical Center Groningen,the Netherlands.
⁹ Professor, Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit;and Head of Research Department,Arkin Mental Health Institute,the Netherlands.
¹⁰ Professor of Experimental Psychopathology,Chair of Department of Clinical Psychology and Experimental Psychopathology,University of Groningen,the Netherlands.
¹¹ Emeritus Professor,Department of Psychiatry,University of Groningen, University Medical Center Groningen,the Netherlands.
¹² Professor of Psychiatry,Head of the Department of Psychiatry,Radboud University Medical Center;and Principal Investigator,Donders Institute for Brain,Cognition and Behavior,Radboud University,the Netherlands.
¹³ Professor of Psychology, Department of Psychology,Vanderbilt University,USA.
¹⁴ Associate Professor of Clinical Epidemiology,Department of General Practice,University of Groningen, University Medical Center Groningen;and Associate Professor of Clinical Epidemiology,Amsterdam UMC, location AMC,Department of Psychiatry,University of Amsterdam,the Netherlands.
¹⁵ Professor of Clinical Psychology in Psychiatry,Amsterdam UMC, location AMC,Department of Psychiatry,University of Amsterdam,the Netherlands.

PMID: 30762507
PMCID: PMC6381417
DOI: 10.1192/bjo.2018.81

Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

Nicola S Klein et al. BJPsych Open. 2019 Jan.

. 2019 Jan;5(1):e12.

doi: 10.1192/bjo.2018.81.

Authors

Affiliations

¹ PhD Candidate,Department of Clinical Psychology and Experimental Psychopathology,University of Groningen;and Psychologist, Top Referent Traumacentrum,GGZ Drenthe,the Netherlands.
² Health Economist,Center of Economic Evaluation,Trimbos Institute (Netherlands Institute of Mental Health and Addiction);and Postdoctoral Researcher,Department of Health Services Research,Maastricht University,Care and Public Health Research Institute CAPHRI,the Netherlands.
³ Director, Center of Economic Evaluation,Trimbos Institute (Netherlands Institute of Mental Health and Addiction),the Netherlands;and Harkness Fellow in Health Care Policy and Practice,Department of Health Care Policy,Harvard Medical School,USA.
⁴ Professor of Health Technology Assessment,Faculty of Economics and Business,University Medical Center Groningen, University of Groningen,the Netherlands.
⁵ PhD Candidate,Department of Clinical Psychology and Experimental Psychopathology,University of Groningen;and Clinical Psychologist,Accare,the Netherlands.
⁶ Health Care Psychologist,Department of Early Detection and Intervention in Psychosis,GGZ Drenthe,the Netherlands.
⁷ Senior Researcher,Lentis Psychiatric Institute,Lentis Research,the Netherlands.
⁸ Professor of Psychiatric Epidemiology,University Center for Psychiatry and Interdisciplinary Center Psychiatric Epidemiology,University of Groningen, University Medical Center Groningen,the Netherlands.
⁹ Professor, Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit;and Head of Research Department,Arkin Mental Health Institute,the Netherlands.
¹⁰ Professor of Experimental Psychopathology,Chair of Department of Clinical Psychology and Experimental Psychopathology,University of Groningen,the Netherlands.
¹¹ Emeritus Professor,Department of Psychiatry,University of Groningen, University Medical Center Groningen,the Netherlands.
¹² Professor of Psychiatry,Head of the Department of Psychiatry,Radboud University Medical Center;and Principal Investigator,Donders Institute for Brain,Cognition and Behavior,Radboud University,the Netherlands.
¹³ Professor of Psychology, Department of Psychology,Vanderbilt University,USA.
¹⁴ Associate Professor of Clinical Epidemiology,Department of General Practice,University of Groningen, University Medical Center Groningen;and Associate Professor of Clinical Epidemiology,Amsterdam UMC, location AMC,Department of Psychiatry,University of Amsterdam,the Netherlands.
¹⁵ Professor of Clinical Psychology in Psychiatry,Amsterdam UMC, location AMC,Department of Psychiatry,University of Amsterdam,the Netherlands.

PMID: 30762507
PMCID: PMC6381417
DOI: 10.1192/bjo.2018.81

Abstract

Background: As depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (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 €6814, €10 264 and €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.Declaration of interestC.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.

Keywords: Depressive disorders; antidepressants; cognitive behavioural therapies; cost-effectiveness; economics.

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Figures

**Fig. 1**
Incremental cost-effectiveness planes ((a) and (c)) and cost-effectiveness acceptability curves ((b) and (d)) for costs per depression-free day ((a) and (b)) and costs per quality-adjusted life-years (QALYs) gained ((c) and (d)) for preventive cognitive therapy plus antidepressants compared with antidepressants only.

**Fig. 2**
Incremental cost-effectiveness planes ((a) and (c)) and cost-effectiveness acceptability curves ((b) and (d)) for costs per depression-free day ((a) and (b)) and costs per quality-adjusted life-years (QALYs) gained ((c) and (d)) for antidepressants only compared with preventive cognitive therapy with guided tapering of antidepressants.

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Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

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Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

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