Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents

Haby, Michelle M., Tonge, Bruce, Littlefield, Lyn, Carter, Rob and Vos, Theo 2004, Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents, Australian and New Zealand journal of psychiatry, vol. 38, no. 8, pp. 579-591.

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Title Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents
Author(s) Haby, Michelle M.
Tonge, Bruce
Littlefield, Lyn
Carter, Rob
Vos, Theo
Journal name Australian and New Zealand journal of psychiatry
Volume number 38
Issue number 8
Start page 579
End page 591
Publisher Taylor & Francis Ltd.
Place of publication Abingdon, England
Publication date 2004-08
ISSN 0004-8674
1440-1614
Keyword(s) antidepressive agents
depressive disorder
meta-analysis
cost effectiveness
cognitive behaviour therapy
Summary Objective:
To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to ‘current practice’.
Method:
The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analysis of randomised controlled trials. An assessment on second stage filter criteria (‘equity’; ‘strength of evidence’, ‘feasibility’ and ‘acceptability to stakeholders’) is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are tracked for the duration of a new episode of MDD arising in eligible children (age 6–17 years) in the Australian population in the year 2000. Simulation-modelling techniques are used to present a 95% uncertainty interval (UI) around the cost-effectiveness ratios.
Results:
Compared to current practice, CBT by public psychologists is the most costeffective intervention for MDD in children and adolescents at A$9000 per DALY saved (95% UI A$3900 to A$24 000). SSRIs and CBT by other providers are less cost-effective but likely to be less than A$50 000 per DALY saved (> 80% chance). CBT is more effective than SSRIs in children and adolescents, resulting in a greater total health benefit (DALYs saved) than could be achieved with SSRIs. Issues that require attention for the CBT intervention include equity concerns, ensuring an adequate workforce, funding arrangements and acceptability to various stakeholders.
Conclusions:
Cognitive behavioural therapy provided by a public psychologist is the most
effective and cost-effective option for the first-line treatment of MDD in children and adolescents. However, this option is not currently accessible by all patients and will require change in policy to allow more widespread uptake. It will also require ‘start-up’ costs and attention to ensuring an adequate workforce.
Language eng
Field of Research 111714 Mental Health
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2004, Taylor & Francis Ltd.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30009380

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