title: Refining cost-effectiveness analyses using the net benefit approach and econometric methods: an example from a trial of anti-depressant treatment.
abstract: BACKGROUND
  Economic evaluation analyses can be enhanced by employing regression methods, allowing for the identification of important sub-groups and to adjust for imperfect randomisation in clinical trials or to analyse non-randomised data.
  
  
  OBJECTIVE
  To explore the benefits of combining regression techniques and the standard Bayesian approach to refine cost-effectiveness analyses using data from randomised clinical trials.
  
  
  METHODS
  Data from a randomised trial of anti-depressant treatment were analysed and a regression model was used to explore the factors that have an impact on the net benefit (NB) statistic with the aim of using these findings to adjust the cost-effectiveness acceptability curves. Exploratory sub-samples' analyses were carried out to explore possible differences in cost-effectiveness. Results The analysis found that having suffered a previous similar depression is strongly correlated with a lower NB, independent of the outcome measure or follow-up point. In patients with previous similar depression, adding an selective serotonin reuptake inhibitors (SSRI) to supportive care for mild-to-moderate depression is probably cost-effective at the level used by the English National Institute for Health and Clinical Excellence to make recommendations.
  
  
  CONCLUSIONS
  This analysis highlights the need for incorporation of econometric methods into cost-effectiveness analyses using the NB approach.
authors: Centre for the Economics of Mental and Physical Health CEMPH, King's College, London SE5 8AF, UK. Ramon.Sabes-Figuera@kcl.ac.uk
authors: Ramon
authors: R
authors: Sabes-Figuera
authors: Paul
authors: P
authors: McCrone
authors: Antony
authors: A
authors: Kendricks
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D001499:Bayes Theorem; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017059:Models, Econometric; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors