Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression

Vos, Theo, Corry, Justine, Haby, Michelle, Carter, Rob and Andrews, Gavin 2005, Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression, Australian and New Zealand journal of psychiatry, vol. 39, no. 8, pp. 683-692.

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Title Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression
Author(s) Vos, Theo
Corry, Justine
Haby, Michelle
Carter, Rob
Andrews, Gavin
Journal name Australian and New Zealand journal of psychiatry
Volume number 39
Issue number 8
Start page 683
End page 692
Publisher Wiley Interscience
Place of publication Malden, Mass.
Publication date 2005
ISSN 0004-8674
1440-1614
Keyword(s) antidepressants
CBT
cost-effectiveness
depression
Summary 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.
Notes Published Online: 28 Jul 2005
Language eng
Field of Research 111714 Mental Health
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2006 The Authors; Journal compilation and The Royal Australian and New Zealand College of Psychiatrists
Persistent URL http://hdl.handle.net/10536/DRO/DU:30006603

Document type: Journal Article
Collection: School of Health and Social Development
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