TY - JOUR
T1 - Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder
T2 - a multisite non-randomized-controlled trial in primary care (INFAP study)
AU - Rubio-Valera, Maria
AU - Peñarrubia-María, María Teresa
AU - Iglesias-González, Maria
AU - Knapp, Martin
AU - McCrone, Paul
AU - Roig, Marta
AU - Sabes-Figuera, Ramón
AU - Luciano, Juan V.
AU - Mendive, Juan M.
AU - Murrugara-Centurión, Ana Gabriela
AU - Alonso, Jordi
AU - Serrano-Blanco, Antoni
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background: The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild–moderate major depressive disorder. Methods: This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners’ clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost–utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. Results: At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). Conclusions: Incremental cost–utility ratios favor pharmacological treatment as a first-line approach for patients with mild–moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild–moderate major depressive patients as an alternative to active monitoring in PC.
AB - Background: The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild–moderate major depressive disorder. Methods: This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners’ clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost–utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. Results: At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). Conclusions: Incremental cost–utility ratios favor pharmacological treatment as a first-line approach for patients with mild–moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild–moderate major depressive patients as an alternative to active monitoring in PC.
KW - Antidepressant medication
KW - Depression/mood disorder
KW - Health economics
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=85061248247&partnerID=8YFLogxK
U2 - 10.1007/s10198-019-01034-5
DO - 10.1007/s10198-019-01034-5
M3 - Article
C2 - 30725226
AN - SCOPUS:85061248247
SN - 1618-7598
VL - 20
SP - 703
EP - 713
JO - European Journal of Health Economics
JF - European Journal of Health Economics
IS - 5
ER -