title: Cost-effectiveness of family psychoeducation to prevent relapse in major depression: results from a randomized controlled trial.
abstract: BACKGROUND
  Family psychoeducation is a relatively simple and straightforward intervention whose prophylactic effectiveness and cost-effectiveness is well-established for schizophrenia. We have recently demonstrated its effectiveness for unipolar depression, but its cost-effectiveness has never been examined. We hereby report a cost-effectiveness analysis alongside a randomized controlled trial in order to assess its cost-effectiveness for preventing relapse/recurrence in depression.
  
  
  METHODS
  Fifty-seven patients diagnosed with major depression and undergoing its maintenance treatment, and their primary family members were randomized to treatment as usual (TAU) only or to TAU plus family psychoeducation, which consisted of four 2-hour multiple-family sessions consisting of didactic lectures about depression (30 minutes) and group discussion and problem solving (60-90 minutes). The economic analyses were undertaken from the perspective of the National Health Insurance (NHI), assuming the most reasonable price of US$50 per psychoeducation session per patient. The main outcome measures included relapse-free days and direct costs to the NHI.
  
  
  RESULTS
  The intervention group enjoyed 272 (SD: 7.1) relapse-free days, while the control group spent 214 (SD: 90.8) relapse-free days (Cox proportional hazard ratio=0.17, 95%CI: 0.04 to 0.75, p=0.002). Cost-effectiveness acceptability curves suggested that the family psychoeducation has 90% or more chances of being cost-effective if the decision-maker is prepared to pay US$20 for one additional relapse-free day. This cost-effectiveness finding was robust when the price for family psychoeducation ranged between 50% to 150% of the baseline scenario in sensitivity analyses. If a relapse-free day is considered to be worth $30 or more, all the pricing scenarios have a close to 100% probability of being cost-effective.
  
  
  CONCLUSIONS
  Family psychoeducation is effective in the relapse prevention of depression and is highly likely to be cost-effective if a relapse-free day is valued as US$20 or more.
  
  
  BACKGROUND
  UMIN-CTR (UMIN000005555).
authors.affiliation: Department of Neuropsychiatry, Kochi Medical School, Kohatsu, Kochi 783-8505, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Shimodera
authors.forename: Toshi A
authors.initials: TA
authors.lastname: Furukawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Mino
authors.forename: Kae
authors.initials: K
authors.lastname: Shimazu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
authors.forename: Shimpei
authors.initials: S
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005196:Family Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics*; D011340:Problem Solving; D055502:Secondary Prevention; D016896:Treatment Outcome