Cost‐effectiveness and cost‐utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (prozac) in treating depression: a randomized clinical trial

Abstract

Cost-effectiveness and cost-utility of cognitive therapy (CT), rational emotive behavioral therapy (REBT), and fluoxetine (Prozac) for major depressive disorder (MDD) were compared in a randomized clinical trial with a Romanian sample of 170 clients. Each intervention was offered for 14 weeks, plus three booster sessions. Beck Depression Inventory (BDI) scores were obtained prior to intervention, 7 and 14 weeks following the start of intervention, and 6 months following completion of intervention. CT, REBT, and fluoxetine did not differ significantly in changes in the BDI, depression-free days (DFDs), or Quality-Adjusted Life Years (QALYs). Average BDI scores decreased from 31.1 before treatment to 9.7 six months following completion of treatment. Due to lower costs, both psychotherapies were more cost-effective, and had better cost-utility, than pharmacotherapy: median $26.44/DFD gained/month for CT and $23.77/DFD gained/month for REBT versus $34.93/DFD gained/month for pharmacotherapy, median $/QALYs=$1,638, $1,734, and $2,287 for CT, REBT, and fluoxetine (Prozac), respectively.

The benzodiazepines use and psychological intervention in a Porto health center

“…But, it seems to be an interesting indicator that participants who have completed psychological intervention process have almost half of the probability to consume benzodiazepines compared to those who are still in psychological intervention. Additionally, psychological intervention seems to promote a reduction in pharmacological substances consumption in general (17,36) and consequently, seems to decrease the number of general and family medicine consultations, minimize treatment costs and increase patient well-being (17). Another Apesar de cerca de 90% dos utilizadores de benzodiazepinas iniciarem o consumo no contexto de uma relação médico-doente, uma grande parte deles acaba por incorrer em utilizações consideradas excessivas no que diz respeito ao tempo recomendado para o tratamento, o que terá que levantar questões sobre a sua correta utilização ou mesmo sobre a pertinência da mesma.…”

“…Mais estudos longitudinais serão necessários para confirmar se o acompanhamento psicológico contribui de facto para a diminuição da utilização de benzodiazepinas, mas parece ser um indicador interessante que os participantes que já terminaram os seus processos de intervenção psicológica tenham quase metade da probabilidade de consumir benzodiazepinas quando comparados com aqueles que ainda estão a frequentar esse mesmo processo. Para além disso a intervenção psicológica parece promover uma redução do consumo de fármacos de uma forma geral (17,36) e consequentemente parece diminuir o número de consultas com os médicos e menos gastos na saúde, tornando-se mais rentável para além de aumentar o bem-estar das pessoas (17). Outro dado interessante obtido através deste estudo é o facto de uma boa parte dos utilizadores de benzodiazepinas manifestar vontade em beneficiar de apoio psicológico.…”

The Responsiveness of Quality of Life Utilities to Change in Depression: A Comparison of Instruments (SF-6D, EQ-5D, and DFD)

“…Some economic evaluation studies adopted the method of Lave et al [9] to calculate DFD-based QALYs [10,12]. However, other studies deriving utilities and/or QALYs from the DFDmethod have used a different range then the 0.6 to 1.0 utility, varied the BDI-II or Hamilton Rating Scale-Depression score to attach the minimal and maximal utility, and/or used another depression questionnaire instead of the BDI-II or Hamilton Rating Scale-Depression [11,[13][14][15][16][17][18][19][20][21]. Thus, different studies used different methods to calculate the utility and/or QALY through the DFD method.…”

Use Your Brain: A Neurologically Driven Application of REBT With Children

“…Many professional counselors and therapists use this approach in broad ways. Some use cognitive theory as their foundational orientation, while others combine cognitive ideas with other approaches (Hughes & Bryan, 2003;Nico & Daprati, 2009;Sava et al, 2009). Counseling professionals who treat children may rely too heavily on verbal interactions.…”

“…By incorporating art, color, and texture to teaching a child client the concept that thoughts cause feelings, a counselor can introduce an evidencebased framework to aid the young client. KEYWORDS REBT, brain development, art, young children, learning styles, cognitive therapy, counseling, creativity Cognitive therapies have been proven effective for treating many mental health disorders (David, Szentagotai, Lupu, & Cosman, 2008;Dryden & Still, 2007;Ellis, 2001;Ellis & Dryden, 2007;Sava, Yates, Lupu, Szentagotai, & David, 2009). A primary tenet of all cognitive therapy is thoughts cause feelings.…”