A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (prozac) in the treatment of depression

Antonuccio, David O.; Thomas, Michael R.; Danton, William G.

doi:10.1016/s0005-7894(97)80043-3

Cited by 104 publications

(74 citation statements)

References 59 publications

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“…In a cost-effectiveness analysis of several outcome studies on depression, Antonuccio, Thomas, and Danton (1997) found that over a 2-year period, fluoxetine alone resulted in 33% higher expected costs than individual cognitive behavior therapy and the combination treatment resulted in 23% higher costs than cognitive behavior therapy alone.…”

Section: Depressionmentioning

confidence: 99%

The empirical status of cognitive-behavioral therapy: A review of meta-analyses

Butler

Chapman

Forman

et al. 2006

Clinical Psychology Review

2,723

1,541

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This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT. D 2005 Elsevier Ltd. All rights reserved.Cognitive-behavioral therapy is one of the most extensively researched forms of psychotherapy. Over 120 controlled clinical trials were added to the literature in the eight years between 1986(Hollon & Beck, 1994 and this proliferation has continued (Dobson, 2001). There are now over 325 published outcome studies on cognitive-behavioral interventions. This growth is due in part to the ongoing adaptation of CBT for an increasingly wider range of disorders and problems (Beck, 1997;Salkovskis, 1996). Yet, many questions remain regarding the overall effectiveness of CBT, its differential effectiveness by disorder, the nature of the control groups by which its effectiveness has been established, and the extent to which its effects persist following the cessation of treatment. In this paper we review evidence from meta-analyses that address these questions. Our approach is unique in that we systematically summarize findings across high-quality meta-analyses for 16 different disorders. We focus on direct comparisons of CBT to alternative treatments wherever possible.A review of meta-analyses on CBT outcomes is particularly relevant to the ongoing debate about the comparative efficacy of different treatments (Rounsaville & Carroll, 2002). For instance, a recent review of meta-analyses and 0272-7358/$ -see front matter D

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Section: Depressionmentioning

confidence: 99%

The empirical status of cognitive-behavioral therapy: A review of meta-analyses

Butler

Chapman

Forman

et al. 2006

Clinical Psychology Review

2,723

1,541

View full text Add to dashboard Cite

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“…In fact, two trials have now demonstrated that the preventative effect of prior CT is comparable in magnitude to that produced by keeping patients on ADM (Evans et al, 1992;Hollon et al, 2005). Importantly, the cost estimates in the Hollon et al (2005) study favored prior CT by the time of one year of follow-up, suggesting that CT is not only as clinically efficacious as ADM, but also more cost-effective in the longer term (see also Antonuccio et al, 1997).Although there is a considerable literature regarding the enduring effects of prior CT, less is known about the relative long-term efficacy of other psychosocial treatments. In this regard, it is important to evaluate the potential enduring effects of behavioral activation (BA; Jacobson, Martell, & Dimidjian, 2001;Martell, Addis, & Jacobson, 2001).…”

mentioning

confidence: 94%

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression.

Dobson

Hollon

Dimidjian

et al. 2008

Journal of Consulting and Clinical Psychology

474

281

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We dedicate this study and manuscript to the late Neil S. Jacobson, Ph.D. Dr. Jacobson was the originator of this study and shaped every aspect of its inception and implementation. His untimely death in 1999 left an irreplaceable gap, but his ideas about behavior therapy and his commitment to empirical inquiry have continued to serve as an inspiration and guide. Sandra Coffman and Christopher Martell provided onsite supervision and treatment for the cognitive therapy and behavioral activation conditions, respectively. Steve Sholl and David Kosins provided cognitive therapy. Ruth Herman-Dunn and Tom Linde provided behavioral activation therapy. Linda Cunning, Steven Dager, Kerri Halfant, Helen Hendrickson, and Alan Unis provided pharmacotherapy. Carolyn Bea and Chris Budech coordinated the pharmacotherapy conditions. Peggy Martin completed medical evaluations for the study. Lisa Roberts, and Elizabeth Shilling assisted in the coordination of the study, and David Markley assisted in the training and supervision of the clinical evaluators. Patty Bardina, Evelyn Mercier, Mandy Steiman, and Dan Yoshimoto were project evaluators. Melissa McElrea, Kim Nomensen, and Eric Gortner provided research support. Marina Smith, Jennifer Jones, Patricia Symons, Sonia Venkatraman, and Melissa Wisler conducted the adherence ratings. Virginia Rutter has been an unwavering supporter of this research, for which we are extremely grateful. NIH Public Access AbstractThis study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through one year of follow-up, compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the second year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to medication withdrawal at the level of a nonsignificant trend. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full two-year follow-up, and each was at least as efficacious as continuation medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy, and that both psychotherapies are less expensive and longerlasting alternatives to medication in the treatment of depression. KeywordsBehavioral Activation; Cognitive Therapy; Antidepressant Medication; Major Depression; Relapse; Recurrence Antidepressant medication (ADM) has been shown to prevent the return of symptoms associated with major depression for as long as it is continued or maintained (APA, 2000). However, there is little evidence that having taken ...

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“…Besides the efficacy of CBT in sense of recovery and relapse-prevention that is at least comparable with or even superior to the efficacy of ADM it is important to mention that CBT is also more cost-effective than ADM in the longer term [31]. And not only the efficacy of individual CBT has been well-documented but there are also hints that group CBT seems to be efficacious.…”

Section: Effectiveness and Efficacy Of Cognitive Behavioral Therapy Imentioning

confidence: 99%