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The Cost-Effectiveness of Cognitive Behavioral Therapy Versus Second-Generation Antidepressants for Initial Treatment of Major Depressive Disorder in the United States: A Decision Analytic Model.
Ross EL, Vijan S, Miller EM, Valenstein M, Zivin K. The Cost-Effectiveness of Cognitive Behavioral Therapy Versus Second-Generation Antidepressants for Initial Treatment of Major Depressive Disorder in the United States: A Decision Analytic Model. Annals of internal medicine. 2019 Dec 3; 171(11):785-795.
Most guidelines for major depressive disorder recommend initial treatment with either a second-generation antidepressant (SGA) or cognitive behavioral therapy (CBT). Although most trials suggest that these treatments have similar efficacy, their health economic implications are uncertain.
To quantify the cost-effectiveness of CBT versus SGA for initial treatment of depression.
Decision analytic model.
Relative effectiveness data from a meta-analysis of randomized controlled trials; additional clinical and economic data from other publications.
Adults with newly diagnosed major depressive disorder in the United States.
1 to 5 years.
Health care sector and societal.
Initial treatment with either an SGA or group and individual CBT.
Costs in 2014 U.S. dollars, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
Results of Base-Case Analysis:
In model projections, CBT produced higher QALYs (3 days more at 1 year and 20 days more at 5 years) with higher costs at 1 year (health care sector, $900; societal, $1500) but lower costs at 5 years (health care sector, -$1800; societal, -$2500).
Results of Sensitivity Analysis:
In probabilistic sensitivity analyses, SGA had a 64% to 77% likelihood of having an incremental cost-effectiveness ratio of $100 000 or less per QALY at 1 year; CBT had a 73% to 77% likelihood at 5 years. Uncertainty in the relative risk for relapse of depression contributed the most to overall uncertainty in the optimal treatment.
Long-term trials comparing CBT and SGA are lacking.
Neither SGAs nor CBT provides consistently superior cost-effectiveness relative to the other. Given many patients'' preference for psychotherapy over pharmacotherapy, increasing patient access to CBT may be warranted.
Primary Funding Source:
Department of Veterans Affairs, National Institute of Mental Health.