title: Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: economic analysis.
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 pounds sterling vs 302 pounds sterling , 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 pounds sterling), 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 pounds sterling 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 of K (INMB = 406 pounds sterling when K = 2,500 pounds sterling).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trent Institute for Health Services Research, School of Community Health Sciences, University of Nottingham, Queens Medical Centre, UK. paul.miller@nottingham.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Miller
authors.forename: Clair
authors.initials: C
authors.lastname: Chilvers
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.forename: Katherine
authors.initials: K
authors.lastname: Fielding
authors.forename: Virginia
authors.initials: V
authors.lastname: Gretton
authors.forename: Ben
authors.initials: B
authors.lastname: Palmer
authors.forename: David
authors.initials: D
authors.lastname: Weller
authors.forename: Richard
authors.initials: R
authors.lastname: Churchill
authors.forename: Idris
authors.initials: I
authors.lastname: Williams
authors.forename: Navjot
authors.initials: N
authors.lastname: Bedi
authors.forename: Conor
authors.initials: C
authors.lastname: Duggan
authors.forename: Alan
authors.initials: A
authors.lastname: Lee
authors.forename: Glynn
authors.initials: G
authors.lastname: Harrison
mesh_terms: D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000191:economics*; D011613:Psychotherapy / Q000191:economics*; D013222:State Medicine; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents