Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline.
BACKGROUND
Treatment options for depression include antidepressants, psychological therapy and a combination of the two.


OBJECTIVE
To develop cost-effective clinical guidelines.


METHODS
Systematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.


RESULTS
Over the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was 4056 UK pounds (95% CI1400-18300); the cost per quality-adjusted life year gained was 5777 UK pounds (95% CI1900-33 800) for severe depression and 14 540 UK pounds (95% CI 4800-79 400) for moderate depression.


CONCLUSIONS
Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.
Simon
Judit
J
Health Economics Research Centre, Old Road Campus, Headington, Oxford OX3 7LF, UK. judit.simon@dphpc.ox.ac.uk
Pilling
Stephen
S
Burbeck
Rachel
R
Goldberg
David
D
D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods*; D003661:Decision Support Techniques; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D000928:Antidepressive Agents