Koeser, L., Donisi, V., Goldberg, D. P. and Mccrone, P. ORCID: 0000-0001-7001-4502 (2015) Modelling the cost-effectiveness of pharmacotherapy compared with cognitive–behavioural therapy and combination therapy for the treatment of moderate to severe depression in the UK. Psychological Medicine, 45 (14). pp. 3019-3031. ISSN 0033-2917 (Print), 1469-8978 (Online) (doi:https://doi.org/10.1017/S0033291715000951)

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Abstract

Background.
The National Institute of Health and Care Excellence (NICE) in England and Wales recommends the combination of pharmacotherapy and psychotherapy for the treatment of moderate to severe depression. However, the cost-effectiveness analysis on which these recommendations are based have not included psychotherapy as monotherapy as a potential option. For this reason, we aimed to update, augment and refine the existing economic evaluation.

Methods.
We constructed a decision analytic model with a 27-month time horizon. We compared pharmacotherapy with cognitive behavioural therapy (CBT) and combination treatment for moderate to severe depression in secondary care from a healthcare service perspective. We reviewed the literature to identify relevant evidence and, where possible, synthesised evidence from clinical trials in a meta-analysis to inform model parameters.

Results.
The model suggested that CBT as monotherapy was most likely to be the most cost-effective treatment option a cost per QALY threshold above £22,000. It dominated combination treatment and had an incremental cost-effectiveness ratio of £20,039 per quality-adjusted life year compared to pharmacotherapy. There was significant decision uncertainty in the probabilistic and deterministic sensitivity analyses.

Conclusions.
Contrary to previous NICE guidance, the results indicated that even for those patients for whom pharmacotherapy is acceptable, CBT as monotherapy may be a cost-effective treatment option. However, this conclusion was based on a limited evidence base, particularly for combination treatment. In addition, this evidence cannot easily be transferred to a primary care setting.

Item Type:	Article
Uncontrolled Keywords:	depression, cost-effectiveness, economic evaluation, model, cognitive behavioural therapy
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RM Therapeutics. Pharmacology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences
Last Modified:	16 Mar 2020 09:57
URI:	http://gala.gre.ac.uk/id/eprint/26353

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