Evidence of cost-effective treatments for depression: a systematic review.
BACKGROUND
High levels of public spending, rising costs of treatments and scarcity of mental health resources have intensified the need for information on the cost-effectiveness of interventions for depression. There have been few reviews that consider the cost-effectiveness of all treatments for depression together.


METHODS
Systematic review of published economic evaluations of interventions for depression to identify where evidence of cost-effectiveness exists and where ambiguity remains.


RESULTS
Fifty-eight papers met the criteria and were included in the review. The quality of the evaluations varied greatly. Evidence establishing the cost-effectiveness of interventions for depression is accumulating; selective serotonin reuptake inhibitors (SSRI) and the newer antidepressants venlafaxine, mirtazepine and nefazodone appear cost-effective compared with older drugs. Despite the availability of high quality economic evaluations of psychological therapies compared to usual care, there is limited evidence of their cost-effectiveness particularly when compared directly to pharmacotherapies. Changes to health systems have been found to be cost-effective in some patient groups, but there is no evidence that screening in primary care populations is a cost-effective strategy.


CONCLUSIONS
Vastly different interventions, outcome measures and cost perspectives meant a meta-analysis of costs and effects was not considered possible.


CONCLUSIONS
On the basis of available evidence, it is not possible to identify the most cost-effective strategy for alleviating the symptoms of depression, although the SSRIs and newer antidepressants consistently appear more cost-effective than tricyclic antidepressants in many patient groups. Better quality economic evidence is needed.
Barrett
Barbara
B
Centre for the Economics of Mental Health, Institute of Psychiatry, Box P024, SE5 8AF, London, UK. b.barrett@iop.kcl.ac.uk
Byford
Sarah
S
Knapp
Martin
M
D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics* / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000191:economics / Q000379:methods
D000928:Antidepressive Agents