title: Economic evaluation of St. John's wort (Hypericum perforatum) for the treatment of mild to moderate depression.
abstract: BACKGROUND
  The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with Complementary and Alternative Medicines. Clinical controlled trials have found St. John's wort to be as effective as antidepressants in the treatment of mild to moderate depression. The objective of this study was to develop a model to assess the cost-effectiveness of St. John's wort based on this evidence.
  
  
  METHODS
  A Markov model was constructed to estimate health and economic impacts of St. John's wort versus antidepressants. Outcomes were treatment costs, quality-adjusted life years (QALYs) and Net Monetary Benefits (NMB). Probabilistic analyses were conducted on key model parameters.
  
  
  RESULTS
  The average NMB across 5000 simulations identified St. John's wort as the strategy with the highest net benefit. The total cost savings for SJW were $359.66 and $202.56 per individual for venlafaxine and sertraline respectively, with a gain of 0.08 to 0.12 QALYs over the 72 weeks of the model.
  
  
  CONCLUSIONS
  A lack of direct comparative clinical trial data comparing SJW to venlafaxine and limited data with sertraline as a comparator was a major limitation.
  
  
  CONCLUSIONS
  In this model, St. John's wort was shown to be a cost-effective alternative to generic antidepressants. Patients are more likely to receive treatment for a duration consistent with professional guidelines for treatment of major depression due to reduced incidence of adverse effects, improving outcomes. This represents an important option in the treatment of Major Depressive Disorder.
authors.affiliation: School of Population Health, University of Queensland, Herston Road Herston, QLD 4006, Australia. d.solomon1@uq.edu.au
authors.forename: Daniela
authors.initials: D
authors.lastname: Solomon
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics; D001315:Australia; D003362:Cost-Benefit Analysis; D003511:Cyclohexanols / Q000191:economics / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000191:economics; D006801:Humans; D020902:Hypericum; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D008517:Phytotherapy / Q000191:economics*; D028321:Plant Preparations / Q000191:economics* / Q000627:therapeutic use*; D020280:Sertraline / Q000191:economics / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D003511:Cyclohexanols; D028321:Plant Preparations; D000069470:Venlafaxine Hydrochloride; D020280:Sertraline