Koeser, Leonardo, Rost, Felicitas, Gabrio, Andrea, Booker, Thomas, Taylor, David, Fonagy, Peter, Goldberg, David, Knapp, Martin and Mccrone, Paul ORCID: 0000-0001-7001-4502 (2023) Cost-effectiveness of long-term psychoanalytic psychotherapy for treatment-resistant depression: RCT evidence from the Tavistock Adult Depression Study (TADS). Journal of Affective Disorders, 335. pp. 313-321. ISSN 0165-0327 (doi:https://doi.org/10.1016/j.jad.2023.04.109)

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Abstract

Background: Treatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoanalytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP+TAU.
Methods: We conducted a within-trial economic evaluation using a Bayesian framework.
Results: Quality-adjusted life years (QALYs) were 0.16 higher in the LTPP+TAU group compared with TAU. The direct cost of LTPP was £5500, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP+TAU group were £5000 more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was ≈£33,000/QALY; the probability that LTPP+TAU was cost-effective at a willingness to pay of £20,000/QALY was 18%.
Limitations: The sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50% at all time points. The study was conducted at a single site, potentially reducing generalizability.
Conclusions: Although LTPP+TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation.

Item Type:	Article
Uncontrolled Keywords:	depression; cost-effectiveness; economic evaluation
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Health Sciences (HEA)
Last Modified:	04 Jul 2023 14:42
URI:	http://gala.gre.ac.uk/id/eprint/42550

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