TY - JOUR
T1 - Cost-effectiveness analyses of augmented cognitive behavioral therapy for pharmacotherapy-resistant depression at secondary mental health care settings
AU - Sado, Mitsuhiro
AU - Koreki, Akihiro
AU - Ninomiya, Akira
AU - Kurata, Chika
AU - Mitsuda, Dai
AU - Sato, Yasunori
AU - Kikuchi, Toshiaki
AU - Fujisawa, Daisuke
AU - Ono, Yutaka
AU - Mimura, Masaru
AU - Nakagawa, Atsuo
N1 - Funding Information:
The authors thank Kimio Yoshimura, MD, PhD of the Keio University School of Medicine, for his comments as a member of the Data Safety Monitoring Committee. The authors also appreciate the support provided by Yoko Ito, MS and Kayoko Kikuchi, PhD of the Project Management Office at the Keio Center for Clinical Research, for the construction of the electronic system and data management. These individuals reported no relevant financial disclosures.
Funding Information:
This study was funded by Health Labour Sciences Research grants from the Japanese Ministry of Health, Labour, and Welfare. YO has received research support from the Japanese Ministry of Health, Labour, and Welfare and royalties from Igaku‐Shoin, Seiwa‐Shoten, Sogensha, and Kongo‐ Shuppan. DF has received royalties from Seiwa‐Shoten. The other authors have no conflicts of interest to declare.
Publisher Copyright:
© 2021 The Authors Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology
PY - 2021/11
Y1 - 2021/11
N2 - Aim: Pharmacotherapy is the primary treatment strategy in major depression. However, two-thirds of patients remain depressed after the initial antidepressant treatment. Augmented cognitive behavioral therapy (CBT) for pharmacotherapy-resistant depression in primary mental health care settings proved effective and cost-effective. Although we reported the clinical effectiveness of augmented CBT in secondary mental health care, its cost-effectiveness has not been evaluated. Therefore, we aimed to compare the cost-effectiveness of augmented CBT adjunctive to treatment as usual (TAU) and TAU alone for pharmacotherapy-resistant depression at secondary mental health care settings. Methods: We performed a cost-effectiveness analysis at 64 weeks, alongside a randomized controlled trial involving 80 patients who sought depression treatment at a university hospital and psychiatric hospital (one each). The cost-effectiveness was assessed by the incremental cost-effectiveness ratio (ICER) that compared the difference in costs and quality-adjusted life years, and other clinical scales, between the groups. Results: The ICERs were JPY −15 278 322 and 2 026 865 for pharmacotherapy-resistant depression for all samples and those with moderate/severe symptoms at baseline, respectively. The acceptability curve demonstrates a 0.221 and 0.701 probability of the augmented CBT being cost-effective for all samples and moderate/severe depression, respectively, at the threshold of JPY 4.57 million (GBP 30 000). The sensitivity analysis supported the robustness of our results restricting for moderate/severe depression. Conclusion: Augmented CBT for pharmacotherapy-resistant depression is not cost-effective for all samples including mild depression. In contrast, it appeared to be cost-effective for the patients currently manifesting moderate/severe symptoms under secondary mental health care.
AB - Aim: Pharmacotherapy is the primary treatment strategy in major depression. However, two-thirds of patients remain depressed after the initial antidepressant treatment. Augmented cognitive behavioral therapy (CBT) for pharmacotherapy-resistant depression in primary mental health care settings proved effective and cost-effective. Although we reported the clinical effectiveness of augmented CBT in secondary mental health care, its cost-effectiveness has not been evaluated. Therefore, we aimed to compare the cost-effectiveness of augmented CBT adjunctive to treatment as usual (TAU) and TAU alone for pharmacotherapy-resistant depression at secondary mental health care settings. Methods: We performed a cost-effectiveness analysis at 64 weeks, alongside a randomized controlled trial involving 80 patients who sought depression treatment at a university hospital and psychiatric hospital (one each). The cost-effectiveness was assessed by the incremental cost-effectiveness ratio (ICER) that compared the difference in costs and quality-adjusted life years, and other clinical scales, between the groups. Results: The ICERs were JPY −15 278 322 and 2 026 865 for pharmacotherapy-resistant depression for all samples and those with moderate/severe symptoms at baseline, respectively. The acceptability curve demonstrates a 0.221 and 0.701 probability of the augmented CBT being cost-effective for all samples and moderate/severe depression, respectively, at the threshold of JPY 4.57 million (GBP 30 000). The sensitivity analysis supported the robustness of our results restricting for moderate/severe depression. Conclusion: Augmented CBT for pharmacotherapy-resistant depression is not cost-effective for all samples including mild depression. In contrast, it appeared to be cost-effective for the patients currently manifesting moderate/severe symptoms under secondary mental health care.
KW - antidepressant
KW - cognitive behavioral therapy
KW - combination therapy
KW - cost-effectiveness
KW - pharmacotherapy-resistant depression
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U2 - 10.1111/pcn.13298
DO - 10.1111/pcn.13298
M3 - Article
C2 - 34459077
AN - SCOPUS:85114955960
SN - 1323-1316
VL - 75
SP - 341
EP - 350
JO - Psychiatry and Clinical Neurosciences
JF - Psychiatry and Clinical Neurosciences
IS - 11
ER -
