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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

Published online by Cambridge University Press:  04 June 2015

L. Koeser ,
V. Donisi ,
D. P. Goldberg  and
P. McCrone
L. Koeser*
Affiliation:
Institute of Psychiatry, King's College London, London, UK
V. Donisi
Affiliation:
Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
D. P. Goldberg
Affiliation:
Institute of Psychiatry, King's College London, London, UK
P. McCrone
Affiliation:
Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: L. Koeser, Health Service and Population Research Department, Institute of Psychiatry, King's College London, Box P024, De Crespigny Park, London SE5 8AF, UK. (Email: leonardo.koeser@kcl.ac.uk)
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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 has not included psychotherapy as monotherapy as a potential option. For this reason, we aimed to update, augment and refine the existing economic evaluation.

Method.

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, synthesized 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 above a threshold of £22 000 per quality-adjusted life year (QALY). It dominated combination treatment and had an incremental cost-effectiveness ratio of £20 039 per QALY compared with 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.

Keywords

Antidepressantscognitive-behavioural therapycost-effectiveness analysisdepressionNational Institute of Health and Care Excellence
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 3019 - 3031
Copyright
Copyright © Cambridge University Press 2015 

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