Decision-analytic modelling to evaluate the cost-effectiveness of interventions to reduce the burden of major depression in Australia

2019 ◽  
Author(s):  
Yong Yi Lee
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Decision Analytic Modelling ◽  
The Cost

scholarly journals Modelling the cost-effectiveness of preventing major depression in general practice patients

2013 ◽  
Vol 44 (7) ◽  
pp. 1381-1390 ◽  
Author(s):  
R. M. Hunter ◽  
I. Nazareth ◽  
S. Morris ◽  
M. King
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Major Depression ◽  
Optimal Choice ◽  
Prevention Programme ◽  
Universal Prevention ◽  
Depression Prevention ◽  
Low Intensity ◽  
Risk Algorithm ◽  
The Cost

BackgroundThe prevention of depression is a key public health policy priority. PredictD is the first risk algorithm for the prediction of the onset of major depression. Our aim in this study was to model the cost-effectiveness of PredictD in depression prevention in general practice (GP).MethodA decision analytical model was developed to determine the cost-effectiveness of two approaches, each of which was compared to treatment as usual (TAU) over 12 months: (1) the PredictD risk algorithm plus a low-intensity depression prevention programme; and (2) a universal prevention programme in which there was no initial identification of those at risk. The model simulates the incidence of depression and disease progression over 12 months and calculates the net monetary benefit (NMB) from the National Health Service (NHS) perspective.ResultsProviding patients with PredictD and a depression prevention programme prevented 15 (17%) cases of depression in a cohort of 1000 patients over 12 months and had the highest probability of being the optimal choice at a willingness to pay (WTP) of £20 000 for a quality-adjusted life year (QALY). Universal prevention was strongly dominated by PredictD plus a depression prevention programme in that universal prevention resulted in less QALYs than PredictD plus prevention for a greater cost.ConclusionsUsing PredictD to identify primary-care patients at high risk of depression and providing them with a low-intensity prevention programme is potentially cost-effective at a WTP of £20 000 per QALY.

Cost-Effectiveness of Cognitive–Behavioural Therapy and Drug Interventions for Major Depression

2005 ◽  
Vol 39 (8) ◽  
pp. 683-692 ◽  
Author(s):  
Theo Vos ◽  
Justine Corry ◽  
Michelle M. Haby ◽  
Rob Carter ◽  
Gavin Andrews
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Maintenance Treatment ◽  
Treatment Options ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold. Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

scholarly journals Cost-effectiveness of interpersonal psychotherapy for elderly primary care patients with major depression

2007 ◽  
Vol 23 (4) ◽  
pp. 480-487 ◽  
Author(s):  
Judith E. Bosmans ◽  
Digna J. F. van Schaik ◽  
Martijn W. Heymans ◽  
Harm W. J. van Marwijk ◽  
Hein P. J. van Hout ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Major Depression ◽  
Elderly Patients ◽  
Health Workers ◽  
Controlled Trial ◽  
Interpersonal Psychotherapy ◽  
Future Research ◽  
Depressed Patients ◽  
The Cost

Objectives:Major depression is common in elderly patients. Interpersonal psychotherapy (IPT) is a potentially effective treatment for depressed elderly patients. The objective of this study was to evaluate the cost-effectiveness of IPT delivered by mental health workers in primary care practices, for depressed patients 55 years of age and older identified by screening, in comparison with care as usual (CAU).Methods:We conducted a full economic evaluation alongside a randomized controlled trial comparing IPT with CAU. Outcome measures were depressive symptoms, presence of major depression, and quality of life. Resource use was measured from a societal perspective over a 12-month period by cost diaries. Multiple imputation and bootstrapping were used to analyze the data.Results:At 6 and 12 months, the differences in clinical outcomes between IPT and CAU were small and nonsignificant. Total costs at 12 months were €5,753 in the IPT group and €4,984 in the CAU group (mean difference, €769; 95 percent confidence interval, −2,459 – 3,433). Cost-effectiveness planes indicated that there was much uncertainty around the cost-effectiveness ratios.Conclusions:Based on these results, provision of IPT in primary care to elderly depressed patients was not cost-effective in comparison to CAU. Future research should focus on improvement of patient selection and treatments that have more robust effects in the acute and maintenance phase of treatment.

scholarly journals Cost-effectiveness of combining systematic identification and treatment of co-morbid major depression for people with chronic diseases: the example of cancer

2013 ◽  
Vol 44 (7) ◽  
pp. 1451-1460 ◽  
Author(s):  
S. Walker ◽  
J. Walker ◽  
G. Richardson ◽  
S. Palmer ◽  
Q. Wu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Cancer Patients ◽  
Integrated Management ◽  
Chronic Medical Condition ◽  
Decision Analytic Model ◽  
Model Parameters ◽  
Usual Practice ◽  
Life Years ◽  
The Cost

BackgroundCo-morbid major depression occurs in approximately 10% of people suffering from a chronic medical condition such as cancer. Systematic integrated management that includes both identification and treatment has been advocated. However, we lack information on the cost-effectiveness of this combined approach, as published evaluations have focused solely on the systematic (collaborative care) treatment stage. We therefore aimed to use the best available evidence to estimate the cost-effectiveness of systematic integrated management (both identification and treatment) compared with usual practice, for patients attending specialist cancer clinics.MethodWe conducted a cost-effectiveness analysis using a decision analytic model structured to reflect both the identification and treatment processes. Evidence was taken from reviews of relevant clinical trials and from observational studies, together with data from a large depression screening service. Sensitivity and scenario analyses were undertaken to determine the effects of variations in depression incidence rates, time horizons and patient characteristics.ResultsSystematic integrated depression management generated more costs than usual practice, but also more quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was £11 765 per QALY. This finding was robust to tests of uncertainty and variation in key model parameters.ConclusionsSystematic integrated management of co-morbid major depression in cancer patients is likely to be cost-effective at widely accepted threshold values and may be a better way of generating QALYs for cancer patients than some existing medical and surgical treatments. It could usefully be applied to other chronic medical conditions.

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