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Economic evidence for the clinical management of major depressive disorder: a systematic review and quality appraisal of economic evaluations alongside randomised controlled trials

Published online by Cambridge University Press:  22 June 2016

E. Karyotaki ,
D. Tordrup ,
C. Buntrock ,
R. Bertollini  and
P. Cuijpers
E. Karyotaki*
Affiliation:
Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands EMGO, Institute of Health Care Research, VU Medical Centre, Amsterdam, The Netherlands
D. Tordrup*
Affiliation:
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, University of Utrecht, The Netherlands
C. Buntrock
Affiliation:
Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands EMGO, Institute of Health Care Research, VU Medical Centre, Amsterdam, The Netherlands Division Health Trainings Online, Leuphana University Innovation Incubator, Lüneburg, Germany
R. Bertollini
Affiliation:
Representation to the EU, WHO, Brussels, Belgium
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands EMGO, Institute of Health Care Research, VU Medical Centre, Amsterdam, The Netherlands
*
*Address for correspondence: E. Karyotaki, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: e.karyotaki@vu.nl) and D. Tordrup, Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Box 80082, 3508 TB Utrecht, The Netherlands. (Email: dtordrup@gmail.com)
*Address for correspondence: E. Karyotaki, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: e.karyotaki@vu.nl) and D. Tordrup, Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Box 80082, 3508 TB Utrecht, The Netherlands. (Email: dtordrup@gmail.com)
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Abstract

Aims.

The aim of this systematic review of economic evaluations alongside randomised controlled trials (RCTs) was to provide a comprehensive overview of the evidence concerning cost-effectiveness analyses of common treatment options for major depression.

Methods.

An existing database was used to identify studies reporting cost-effectiveness results from RCTs. This database has been developed by a systematic literature search in the bibliographic databases of PubMed, PsychINFO, Embase and Cochrane library from database inception to December 2014. We evaluated the quality of economic evaluations using a 10-item short version of the Drummond checklist. Results were synthesised narratively. The risk of bias of the included RCTs was assessed, based on the Cochrane risk of bias assessment tool.

Results.

Fourteen RCTs were included from the 5580 articles screened on titles and abstracts. The methodological quality of the health economic evaluations was relatively high and the majority of the included RCTs had low risk of bias in most of Cochrane items except blinding of participants and personnel. Cognitive behavioural therapy was examined in seven trials as part of a variety of treatment protocols and seems cost-effective compared with pharmacotherapy in the long-term. However cost-effectiveness results for the combination of psychotherapy with pharmacotherapy are conflicting and should be interpreted with caution due to limited comparability between the examined trials. For several treatments, only a single economic evaluation was reported as part of a clinical trial. This was the case for comparisons between different classes of antidepressants, for several types of psychotherapy (behavioural activation, occupational therapy, interpersonal psychotherapy, short-term psychotherapy, psychodynamic psychotherapy, rational emotive behavioural therapy, solution focused therapy), and for transcranial magnetic stimulation v. electroconvulsive therapy. The limited evidence base for these interventions means generalisations, based on economic evaluation alongside clinical trials, cannot easily be made.

Conclusions.

There is some economic evidence underpinning many of the common treatment options for major depression. Wide variability was observed in study outcomes, probably attributable to differences in population, interventions or follow-up periods. For many interventions, only a single economic evaluation alongside clinical trials was identified. Thus, significant economic evidence gaps remain in the area of major depressive disorder.

Keywords

Depressionmood disorders unipolarpsychotherapycognitive therapy
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 5 , October 2017 , pp. 501 - 516
Copyright
Copyright © Cambridge University Press 2016 

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Footnotes

†

These authors share first authorship.

References

Andrade, L, Caraveo-anduaga, JJ, Berglund, P, Bijl, RV, Graaf, RD, Vollebergh, W, Dragomirecka, E, Kohn, R, Keller, M, Kessler, RC, Kawakami, N (2003). The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12, 3–21.Google Scholar
Bosmans, JE, Schaik, DJ, Heymans, MW, Marwijk, HW, Hout, HP, Bruijne, MC (2007). Cost-effectiveness of interpersonal psychotherapy for elderly primary care patients with major depression. International Journal of Technology Assessment in Health Care 23, 480–487.Google Scholar
Byford, S, Barrett, B, Roberts, C, Wilkinson, P, Dubicka, B, Kelvin, RG, White, L, Ford, C, Breen, S, Goodyer, I (2007). Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression. Brtitish Journal of Psychiatry 191, 521–527.Google Scholar
Chisholm, D, Sweeny, K, Sheehan, P, Rasmussen, B, Smit, F, Cuijpers, P, Saxena, S (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry 5, 415–424.Google Scholar
Cuijpers, P, van Straten, A, Andersson, G, van Oppen, P (2008 a). Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909–922.CrossRefGoogle ScholarPubMed
Cuijpers, P, Van Straten, A, Van Oppen, P, Andersson, G (2008 b). Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. Journal of Clinical Psychiatry 69, 1675–1685.CrossRefGoogle ScholarPubMed
Cuijpers, P, Dekker, J, Hollon, SD, Andersson, G (2009). Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. Journal of Clinical Psychiatry 70, 1219–1229.Google Scholar
Cuijpers, P, van Straten, A, van Oppen, P, Andersson, G (2010). Comparing psychotherapy and pharmacotherapy for adult depression: adjusting for differential dropout rates. Journal of Clinical Psychiatry 71, 1246.Google Scholar
Cuijpers, P, Beekman, AT, Reynolds, CF (2012). Preventing depression: a global priority. Jama 307, 1033–1034.CrossRefGoogle ScholarPubMed
Domino, ME, Burns, BJ, Silva, SG, Kratochvil, CJ, Vitiello, B, Reinecke, MA, Mario, J, March, JS (2008). Cost-effectiveness of treatments for adolescent depression: results from TADS. American Journal of Psychiatry 165, 588–96.Google Scholar
Domino, ME, Foster, EM, Vitiello, B, Kratochvil, CJ, Burns, BJ, Silva, SG, Reinecke, MA, March, JS (2009). Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. Journal of the American Academy of Child Adolescent Psychiatry 48, 711–20.Google Scholar
Drummond, MF (2005). Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press: New York.Google Scholar
Ekers, D, Godfrey, C, Gilbody, S, Parrott, S, Richards, DA, Hammond, D, Hayes, A (2011). Cost utility of behavioural activation delivered by the non-specialist. British Journal of Psychiatry 199, 510–1.Google Scholar
Grochtdreis, T, Brettschneider, C, Wegener, A, Watzke, B, Riedel-Heller, S, Harter, M, Konig, HH (2015). Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review. PLoS ONE 10, e0123078.CrossRefGoogle ScholarPubMed
Higgins, J, Altman, DG. (2011). Chapter 8: Assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 (ed. Higgins, J and Green, S) (updated March 2011). The Cochrane Collaboration http://www.cochrane-handbook.org Google Scholar
Higgins, JP, Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 (updated March 2011), Chichester, UK.Google Scholar
Hollinghurst, S, Carroll, FE, Abel, A, Campbell, J, Garland, A, Jerrom, B, Kessler, D, Kuyken, W, Morrison, J, Ridgway, N, Thomas, L, Turner, K, Williams, C, Peters, TJ, Lewis, G, Wiles, N (2014). Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial. British Journal of Psychiatry 204, 69–76.Google Scholar
Karyotaki, E, Smit, Y, Henningsen, KH, Huibers, M, Robays, J, de Beurs, D, Cuijpers, P (2016). Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects. Journal of Affective Disorders.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Knapp, M, Romeo, R, Mogg, A, Eranti, S, Pluck, G, Purvis, R, Brown, RG, Howard, R, Philpot, M, Rothwell, J, Edwards, D, McLoughlin, DM (2008). Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: a multi-centre randomised controlled trial. In Journal of Affective Disorders 109, 273–285.CrossRefGoogle ScholarPubMed
Lee, JC, Blumberger, DM, Fitzgerald, PB, Daskalakis, ZJ, Levinson, AJ (2012). The role of transcranial magnetic stimulation in treatment-resistant depression: a review. Current Pharmaceutical Design 18, 5846–5852.Google Scholar
Lepine, JP, Briley, M (2011). The increasing burden of depression. Neuropsychiatric Disease and Treatment 7, 3–7.Google Scholar
Lynch, FL, Dickerson, JF, Garber, J, Clarke, GN, Weersing, VR, Beardslee, WR, Brent, DA, Gladstone, TRG, DeBar, LL (2011). Cost-effectiveness of a cognitive behavioral intervention to prevent depression in at-risk teens. Journal of Mental Health Policy and Economics 14, S19.Google Scholar
Maljanen, T, Paltta, P, Harkanen, T, Virtala, E, Lindfors, O, Laaksonen Maarit, A, Knekt, P (2012). The cost-effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of depressive and anxiety disorder during a one-year follow-up. Journal of Mental Health Policy and Economics 15, 13–23.Google Scholar
McLoughlin, DM, Mogg, A, Eranti, S, Pluck, G, Purvis, R, Edwards, D, Landau, S, Brown, R, Rabe-Heskith, S, Howard, R, Philpot, M, Rothwell, J, Romeo, R, Knapp, M (2007). The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis. Health Technology Assessment 11, 1–54.Google Scholar
Organisation for Economic Cooperation and Development, OECD (2016 a). OECD Consumer Price Index. Retrieved 10 March 2016 from https://data.oecd.org/price/inflation-cpi.htm Google Scholar
Organisation for Economic Cooperation and Development, OECD (2016 b). OECD Purchasing Power Parities for Private Consumption. Retrieved 10 March 2016 from http://stats.oecd.org/Index.aspx?DataSetCode=SNA_TABLE4 Google Scholar
Rabheru, K (2012). Maintenance electroconvulsive therapy (M-ECT) after acute response: examining the evidence for who, what, when, and how? Journal of Electroconvulsive Therapy 28, 39–47.Google Scholar
Revicki, DA, Siddique, J, Frank, L, Chung, JY, Green, BL, Krupnick, J, Prasad, M, Miranda, J (2005). Cost-effectiveness of evidence-based pharmacotherapy or cognitive behavior therapy compared with community referral for major depression in predominantly low-income minority women. Archives of General Psychiatry 62, 868–875.Google Scholar
Sava, FA, Yates, BT, Lupu, V, Szentagotai, A, David, D (2009). Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (Prozac) in treating depression: a randomized clinical trial. Journal of Clininical Psychology 65, 36–52.Google Scholar
Schene, AH, Koeter, MW, Kikkert, MJ, Swinkels, JA, McCrone, P (2007). Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychological Medicine 37, 351–62.Google Scholar
Shimodera, S, Furukawa, TA, Mino, Y, Shimazu, K, Nishida, A, Inoue, S (2012). Cost-effectiveness of family psychoeducation to prevent relapse in major depression: results from a randomized controlled trial. BMC Psychiatry 12, 40.Google Scholar
Stant, AD, TenVergert, EM, Kluiter, H, Conradi, HJ, Smit, A, Ormel, J (2009). Cost-effectiveness of a psychoeducational relapse prevention program for depression in primary care. Journal of Mental Health Policy and Economics 12, 195–204.Google Scholar
Tordrup, D, Attwill, A, Crosby, L, Bertollini, R (2015). Research Agenda for Health Economic Evaluation – Expert Meeting Report. http://www.euro.who.int/en/RAHEEproject Google Scholar
Tordrup, D, Bertollini, R (2014). Consolidated research agenda needed for health economic evaluation in Europe. British Medical Journal 349, g5228.Google Scholar
Wade, AG, Fernandez, JL, Francois, C, Hansen, K, Danchenko, N, Despiegel, N (2008). Escitalopram and duloxetine in major depressive disorder: a pharmacoeconomic comparison using UK cost data. In Pharmacoeconomics 26, 969–981.CrossRefGoogle ScholarPubMed
Warmerdam, L, Smit, F, Straten, A, Riper, H, Cuijpers, P (2010). Cost-utility and cost-effectiveness of internet-based treatment for adults with depressive symptoms: randomized trial. Journal of Medical Internet Research 12, e53.Google Scholar
World Bank, WB (2015). Inflation, consumer prices. Retrieved 15 March 2016 from http://data.worldbank.org/indicator/FP.CPI.TOTL.ZG/countries/RO?display=default Google Scholar
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