Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial.
OBJECTIVE
The cost-effectiveness of three active interventions for major depression in adolescents was compared after 36 weeks of treatment in the Treatment of Adolescents with Depression Study.


METHODS
Outpatients aged 12 to 18 years with a primary diagnosis of major depression participated in a randomized controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Three hundred twenty-seven participants randomized to 1 of 3 active treatment arms, fluoxetine alone (n = 109), cognitive-behavioral therapy (n = 111) alone, or their combination (n = 107), were evaluated for a 3-month acute treatment and a 6-month continuation/maintenance treatment period. Costs of services received for the 36 weeks were estimated and examined in relation to the number of depression-free days and quality-adjusted life-years. Cost-effectiveness acceptability curves were also generated. Sensitivity analyses were conducted to assess treatment differences on the quality-adjusted life-years and cost-effectiveness measures.


RESULTS
Cognitive-behavioral therapy was the most costly treatment component (mean $1,787 [in monotherapy] and $1,833 [in combination therapy], median $1,923 [for both]). Reflecting higher direct and indirect costs associated with psychiatric hospital use, the costs of services received outside Treatment of Adolescents with Depression Study in fluoxetine-treated patients (mean $5,382, median $2,341) were significantly higher than those in participants treated with cognitive-behavioral therapy (mean $3,102, median $1,373) or combination (mean $2,705, median $927). Accordingly, cost-effectiveness acceptability curves indicate that combination treatment is highly likely (>90%) to be more cost-effective than fluoxetine alone at 36 weeks. Cognitive-behavioral therapy is not likely to be more cost-effective than fluoxetine.


CONCLUSIONS
These findings support the use of combination treatment in adolescents with depression over monotherapy.
Domino
Marisa Elena
ME
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University. Electronic address: domino@unc.edu.
Foster
E Michael
EM
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
Vitiello
Benedetto
B
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
Kratochvil
Christopher J
CJ
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
Burns
Barbara J
BJ
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
Silva
Susan G
SG
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
Reinecke
Mark A
MA
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
March
John S
JS
Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D004311:Double-Blind Method; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005473:Fluoxetine / Q000191:economics* / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine