Counseling Versus Antidepressant Therapy for the Treatment of Mild to Moderate Depression in Primary Care

Abstract

Objective: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months. Methods: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves. Results: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (£342 vs £302, p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K , is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > £0), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional £2,000 or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values ofConclusion: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K . Since we cannot observe K , acceptability curves are a useful way to inform decision makers.

Case study in the Bayesian analysis of a cost‐effectiveness trial in the evaluation of health care technologies: Depression

“…As expected, our analysis based on normal theory has produced results that are similar to those in the original economic evaluation [24] since both are based on an analysis of sample means [16]. In each case, the posterior probability that treatment with antidepressants is cheaper compared to counselling was estimated as approximately 0.45.…”

“…This case study is based on a published trial comparing antidepressant drugs with generic counselling in the treatment of major depression in primary care [23]. An economic evaluation of this study has also been presented [24].…”

Antidepressant Effects on Insulin Sensitivity and Proinflammatory Cytokines in the Depressed Males

“…In Figure 2, is resulted demonstrates without difference of adiponectin level following antidepressant treatment, it would be probably attributed to insufficient change of insulin sensitivity and weight gain in this study. Growing evidence shows elevation of plasma IL-6 and TNF- α concentrations in depressed and diabetic patients and IL-6 represents the higher association with obesity and insulin resistance [42, 43]. TNF- α is an important stimulator of a second wave of cytokines, including IL-6 and other chemokines.…”

Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions

“…CEACs can now be found in major medical journals such as BMJ [1][2][3][4][5], New England Journal of Medicine [6,7], Lancet [8], Circulation [9], Chest [10] as well as health economics and health technology assessment journals [11][12][13][14][15][16][17]. Given the widespread dissemination of this technique it is important to ensure that both analysts and potential users of the information understand the nature and interpretation of these curves.…”