Assessment of the Cost-Effectiveness of CBT or Interpersonal Therapy for Major Depressive Disorder and Generalized Anxiety Disorder. Overall, there was a moderate risk of bias in the studies based on unclear allocation concealment. We found that interpersonal therapy represents good value for money when compared with no treatment. After adjusting for these missing studies, the effect size dropped from an SMD of 0.80 to an SMD of 0.59 (95% CI: 0.440.75). A set of recommended methods used for all evaluations that promote uniformity and transparency and that enable the comparison of results for different technologies and different decisions. The cost-effectiveness of interpersonal therapy, based on 1 study from the Netherlands,58 is uncertain. Enter your username below and we'll send you an email explaining how to change your password. Total costs/100,000 people with MDD, 5 scenarios: Base case analysis, 5 scenarios vs. nothing, average CER (baht/DALY averted): All interventions highly cost-effective, below 1 GDP of 110,000 per capita, Economic analysis: individual-level cost-effectiveness analysis, Older people (mean 74.1 years [SD: 7.0]) with a primary diagnosis of depression, 73.5% not taking antidepressants at baseline, Average point reduction in BDI-II score (mean), CBT vs. usual care: 3.6 (0.76.5); CBT vs. talking therapy: 3.5 (0.36.5), Mean difference, CBT vs. usual care: 427 (95% CI: 56787); CBT vs. talking therapy: 580 (95% CI: 280930), Base case analysis: ICER, CBT vs. usual care: 120 per additional unit reduction in BDI-II score, Base case analysis: ICER, talking therapy vs. usual care): 167 per additional unit reduction in BDI-II score, Probability of CBT being cost-effective if 270 WTP per point reduction in BDI-II score: 90%, Study design: open-label RCT Perspective: Romania, societal Time horizon: 10 months Discount rate: 0%, Intervention 1: CBT by a trained psychotherapist (n = 49), CBT: max. The meaning of the ICER depends on the quadrant(s) of the cost-effectiveness plane in which the ICER resides.131,135 A strategy is considered cost-effective if it is associated with greater expected effects and greater expected costs and if the ICER is below the maximum price that a decision-maker or society is willing to pay for an extra unit of effect.135,136 Although the value of the willingness-to-pay threshold remains controversial,137,138 we used a threshold of $50,000 per QALY gained139 and also examined a threshold of $100,000 per QALY gained. CBT significantly reduces anxiety symptoms posttreatment in patients with generalized anxiety disorder. Our intent at Health Quality Ontario is to continuously improve the quality of health care in this province regardless of who you are or where you live. However, individual CBT represents good value for money and should be available to those patients who are not engaging well with or adhering to group therapy. Wiles N, Thomas L, Abel A, Barnes M, Carroll F, Ridgway N, et al. Average Costs per Patient Each Year Post-Diagnosis of Major Depressive Disorder, Patients at Risk. Content is reviewed before publication and upon substantial updates. Driessen E, Hollon SD, Bockting CL, Cuijpers P, Turner EH. Cognitive-behavioral therapy treatment for major depressive disorder may involve the following steps: According to a 2012 study, cognitive-behavioral therapy is an effective form of treatment for depression, and its effects last even after treatment is completed. Technology in mental health services. King M, Sibbald B, Ward E, Bower P, Lloyd M, Gabbay M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. One should be cautious about long-term use and dose should be decreased as permitted. Total QALYs (mean/person), CBT + pharmacotherapy vs. pharmacotherapy only: Total costs, CBT + pharmacotherapy vs. pharmacotherapy only: 449,655 vs. 422,244. . The results of the probabilistic sensitivity analysis were presented in the cost-effectiveness plane by plotting simulated ICER values. A measurement that takes into account both the number of years gained by a patient from a procedure and the quality of those extra years (ability to function, freedom from pain, etc.). Participation is voluntary. Read our. Adding CBT to usual care over the next 5 years would cost the province between $68 million and $529 million, depending on the type of treatment (group vs. individual) and type of provider (nonphysician vs. physician). When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. The effect of vilazodone on sexual function during the treatment of major depressive disorder. A projected or virtual scenario in which no changes are made to current practice. How Treatment-Resistant Depression is Treated, St. John's Wort Drug Interactions With Antidepressants. In such cases, the patient may have to pay some or all of the treatment costs.15, Research questions are developed by Health Quality Ontario in consultation with experts, end users, and/or applicants in the topic area. Depressive episodes are characterized by: Decreased self-attitudea distinctly lower sense of self-esteem and self-confidence compared to usual for the individual. Figure 2 presents the flow diagram for the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for the economic evidence review. LIFU for major depressive disorder - Open Access Government Abbreviations: CBT, cognitive behavioural therapy; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses. Note: Results may appear incorrect because of rounding. I just wouldn't. The evidence for the incidence of generalized anxiety disorder in Canada and worldwide is scarce148,149; approximately 2.5% of Ontarians are reported to have generalized anxiety disorder.72 After accounting for adults who have both major depressive disorder and generalized anxiety disorder (50%), we arrived at a target population estimate of 147,042 people with generalized anxiety disorder. In terms of clinical outcomes, over a 5-year time horizon, individual CBT increased undiscounted survival (i.e., overall survival or life expectancy) by 0.00278 years (1.015 days) versus usual care, and group CBT increased undiscounted survival by 0.00151 years (0.55 days) versus usual care (see Table 10). Thirteen systematic reviews met the inclusion criteria. To determine the effectiveness of psychological interventions in reducing the relapse or recurrence rates of MDD. Therefore, in the majority of the cost-effectiveness analyses we reviewed, the disorder was considered moderate or severe. Descriptive epidemiology of generalized anxiety disorder in Canada, Public and patient involvement at the UK National Institute for Health and Clinical Excellence, A pilot study to identify areas for further improvements in patient and public involvement in health technology assessments for medicines, Public engagement for health technology assessment at Health Quality Ontariofinal report from the Ontario Health Technology Advisory Committee Public Engagement Subcommittee. However, the cost-effectiveness of structured in-person CBT in populations with mild major depressive disorder or generalized anxiety disorder is largely unknown owing to a lack of economic studies in these populations or our restrictive inclusion criteria regarding the use of computerized CBT. To address all possible scenarios in Ontario, we conducted the following budgetary impact analyses: Our second objective was to determine the number of health care professionals needed to support timely access to CBT in Ontario. A patient may stay in one health state or move from one health state to another, depending on the effect of the treatment and the progression of the disease. Certainly, when I was 25, the formulations of these things were a lot cruder than they are now, and some of them had horrible side effects. The site is secure. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: introduction and methods. All costs are in 2017 Canadian dollars and discounted at 1.5%. They reported that after overcoming the perceived stigma and shame of their mental health issues, which itself was a lengthy process, they faced a long journey to obtain effective and sustainable treatment, whether psychotherapy, pharmacotherapy, or both. Speed T, DePaulo, Jr. JR. Major Depressive Disorder [Internet]. We strive for complete objectivity, and look at things from a vantage point that allows us to see the forest and the trees. For patients with generalized anxiety disorder, CBT improved symptoms posttreatment (SMD: 0.80, 95% CI: 0.670.93), improved clinical response posttreatment (RR: 0.64, 95% CI: 0.550.74), and improved quality-of-life scores (SMD: 0.44, 95% CI: 0.060.82). Depression. . We found that the majority of studies had important limitations, particularly in terms of the assessment of all important health outcomes, the inclusion of all relevant comparators, the relatively short duration of the time horizons used, and the lack of exploration of uncertainty and its influence on the studies' cost-effectiveness estimates. Information shared from lived experience can also identify gaps or limitations in published research (for example, outcome measures that do not reflect what is important to those with lived experience).150152 Additionally, lived experience can provide information or perspectives on the ethical and social values implications of technologies and interventions. especially in people with severe depression. Psychological interventions were not directly compared with each other, We did not include systematic reviews on long-distance or computer/Internet-based psychotherapy, The patient population was restricted to adults; we excluded pediatric and geriatric populations, We considered only major depressive disorder and generalized anxiety disorder; we did not examine other types of depression or anxiety, Treatment with CBT, interpersonal therapy, or supportive therapy reduces symptoms of major depressive disorder and increases response/recovery posttreatment, CBT and interpersonal therapy significantly reduce the risk of relapse/recurrence of major depressive disorder, Individual CBT significantly improves posttreatment recovery from major depressive disorder compared with group CBT, CBT significantly reduces symptoms of generalized anxiety disorder and increases response posttreatment, CBT significantly improves quality-of-life scores in people with generalized anxiety disorder, Combined therapy (CBT with pharmacotherapy) significantly improves treatment response compared with pharmacotherapy only, CBT significantly improves treatment response compared with pharmacotherapy only following termination of both acute interventions, Of the systematic reviews we examined, 3 reported on provider type; in these reviews, a diverse range of providers was described. Throughout the development of this model, we sought expert consultation. An additional strength of our economic modeling study is that we examined the incremental cost-effectiveness of structured in-person psychotherapy versus usual care in the management of adults with first and recurrent episodes of mild or moderate to severe depression and/or anxiety. The results remained robust in all 19 scenarios comparing group or individual CBT provided by nonphysicians or group CBT provided by physicians with usual care (Table 13). Small number of patients within the studies. The session will be conducted in a private location and will be audio-taped. Patients could experience a maximum of 2 major depressive episode recurrences, after which they would enter the complex depression health state and be considered for other type of treatment and secondary psychiatric care. We also used cost-effectiveness acceptability curves to graphically present uncertainty in the ICER.140 These curves show the probability of one alternative being cost-effectiveness over another across a range of willingness-to-pay thresholds ($0 to $100,000/QALY gained). If you have any questions about this collection of this personal information, contact: By signing this form as indicated below, you agree to hereby release and forever discharge the Health Quality Ontario (Ontario Health Quality Council), its officers, employees, agents and representatives from any and all claims, demands, expenses, actions, causes of action and for any and all liability howsoever caused, arising out of, or in any way related to the collection, use and disclosure of information, recordings and images authorized to be collected pursuant to, or on this form. We recognize that, as a system, we have much to be proud of, but also that it often falls short of being the best it can be. Compared with usual care, treatment with CBT, interpersonal therapy, or supportive therapy significantly reduces depression symptoms posttreatment. In modelling studies that favoured CBT over usual care, the probability of cost-effectiveness ranged from 76% to 88% for moderate major depressive disorder and was over 96% for severe major depressive disorder (at a country-specific willingness-to-pay threshold of 30,000 per QALY (United Kingdom)61 or 6.75 million per QALY (Japan).63. For example, we specified the beta distribution for utilities, the normal distribution for the effect measure of treatment efficacy (i.e., the log-odds ratio), and the gamma distribution for costs. Interestingly, if the efficacy of CBT were 25% lower than that reported in the literature, the ICER was greater than $52,000 per QALY (scenario 4; see Table 13). Psychotherapy for Major Depressive Disorder and Generalized Anxiety (36942), cognitive therapy/ or cognitive behavior therapy/ (95840), (((cognitive or behavio*) adj2 (therap* or psychotherap*)) or cognitive behavio* or CBT).ti,ab,id. Elderly patients often manifest depression as somatic symptoms (e.g. (9151), (supportive adj2 (counsel?ing or therap* or psychotherap*)).ti,ab,id. (15968), (systematic review or meta analysis).md. In: * Article titles in AMA citation format should be in sentence-case, You can cancel anytime within the 30-day trial, or continue using Johns Hopkins Guides to begin a 1-year subscription ($39.95). Abbreviations: CBT, cognitive behavioural therapy; ICER, incremental cost-effectiveness ratio; WTP, willingness-to-pay threshold ($). In the first 3 months (i.e., during the acute phase), a hypothetical patient has a chance of dropping out, after which they have a chance of either recovering (transferring to the well health state) or deteriorating (either committing suicide or transferring to the complex depression health state). Cost-effectiveness of interpersonal psychotherapy for elderly primary care patients with major depression. For patients with severe depression (i.e., PHQ-9 score greater than 20), major depression that persists for more than two years, or depression with at least one recurrence, combining psychotherapy . Major Depressive Disorder (MDD): MDD, also known as clinical depression, is a . Every evaluation contains some degree of uncertainty. Rates are equal for pre-pubescent boys and girls; rates in women following menarche are twice that of men. Low self-attitude may manifest as self-blame, self-deprecation, guilt, lack of self-confidence about the future, or hopelessness. The intervention and usual-care strategies depended on the severity of the major depressive disorder episode. Adopting this CBT strategy at a 20% uptake rate would lead to an increase in costs of about $11 million in 2017 and about $68 million in 2021, when full access is achieved. Parikh SV, Segal ZV, Grigoriadis S, Ravindran AV, Kennedy SH, Lam RW, et al. Negative QALYs indicate that the individual CBT strategy was associated with worse quality-adjusted survival, and negative costs indicate that the individual CBT strategy saved money relative to the group CBT strategy. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. First, we compared each strategy with usual care, for three reasons: There is no gold standard regarding the ideal CBT provider type in Ontario, There is limited access to psychotherapy in Ontario, It is possible that some patients may not be able to undergo group therapy and will be deprived from needed individual therapy (i.e., owing to health equity issues), Second, we ranked strategies by costs and benefits, removed inefficient strategies (i.e., dominated strategies associated with equal benefits but greater costs), and determined the ICERs and the best, most cost-effective option in Ontario, Group CBT provided by nonphysician therapists (vs. usual care) would be associated with the following costs: $10,019 to avoid 1 recurrent major depressive episode, $284 to avoid 1 hospitalization, and $729 to save 1 additional day of life, Individual CBT provided by nonphysician therapists (vs. usual care) would be associated with the following costs: $35,200 to avoid one recurrent major depressive episode, $1,956 to avoid one hospitalization, and $3,121 to save 1 additional day of life, From a health equity perspective, it would be unfair to deprive patients of needed individual therapy if they do not engage well with group therapy, The large ICER value comes from a tiny difference in QALYs between individual and group CBT. Partially, severe and treatment-resistant depression. (3085197), (adolescent/ or exp child/ or exp infant/) not exp adult/ (3693427), limit 33 to english language [Limit not valid in CDSR,DARE; records were retained] (1758), ((depression* or depressive* or melancholia*) adj2 (major or disorder* or chronic or treatment resistant or severe or intractable or persistent or acute or clinical or unipolar*)).tw,kw. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness. Antidepressants are a popular treatment choice for depression. By Sanjana Gupta 125 mg amitriptyline) + clinical management (n = 77), CBT: 16 sessions by psychotherapist over 20 weeks with 2 booster sessions, Comparator: clinical management (30-minite appointments with a psychiatrist every 4 weeks during first 20 weeks and every 8 weeks during the next 48 weeks), Relapse rate: CBT vs. control: 29% vs. 47% at 62 weeks (adjusted HR: 0.51, 95% CI: 0.320.92), Total costs including CBT therapy, CBT vs. control: 1,898 (SD: 564) vs. 1,119 (SD: 700), Total costs of CBT only: 1,164 (1,0841,244), Base case analysis: ICER: 4,328 per relapse prevented, additional 12.50 per additional relapse-free day, Probability of CBT being cost-effective at 6,000 and 8,500 WTP per relapse avoided: 60% and 80%, Type of economic analysis: individual-level cost-effectiveness analysis, Control: usual care (psychoeducation only or combined with pharmacotherapy) or no treatment if no request for GP (n = 74), IPT provided in 10 sessions over 5 months by psychologist or psychiatric nurse, Mean change in % recovery by PRIME-MD, IPT vs. usual care: 45.2% vs. 45%, Mean change in MADRS score, IPT vs. usual care: 4.2 vs. 3.0, Mean change in QALYs from baseline to 12 months, IPT vs. usual care: 0.62 (0.24) vs. 0.61 (0.28), Total costs, IPT vs. usual care, at 12 months: 5,753 (SD: 6,797) vs. 4,984 (SD: 7,059), Base-case analysis, IPT vs. usual care, ICER: 76,900/QALY, IPT more effective and more expensive than usual care 93.1% of the time, IPT less effective and more expensive 2.4% of the time, Type of economic analysis: individual-level cost-minimization analysis, Study design: prospective cohort study, participants of a large mental health trust/specialist national psychotherapy service, Adults aged 17 years+ (mean age, intervention vs. control: 36.8 [SD: 10.1] vs. 44.9 [SD: 10.1] years) with MDD, Cohort divided into 2 groups based on clinician referral, On average, participants had lived 16+ years depression, with 23 medications, Intervention: Individual face-to-face CBT (n = 49), CBT: individual, 618 weekly sessions; group, 1012 weekly sessions with 812 participants, Individual and group CBT equally effective in clinical outcomes, Total costs, individual vs. group CBT: 622 (SD: 271) vs. 737 (SD: 271).
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