title: Cost-utility analysis of a treatment advice to discontinue inappropriate long-term antidepressant use in primary care.
abstract: BACKGROUND
  Antidepressant prescriptions have increased exponentially, burdening health care costs.
  
  
  OBJECTIVE
  To evaluate the costs and effects of an antidepressant cessation advice in case of inappropriate long-term use in primary care, i.e. long-term usage without a (current) indication.
  
  
  METHODS
  A economic evaluation during 1-year follow-up was performed, from a societal perspective, as part of a cluster-randomised controlled clinical trial (PANDA). Costs were assessed using the Trimbos/iMTA questionnaire for costs associated with psychiatric illness. Health-related quality of life was measured using the EuroQol 5D. Outcome was costs per quality adjusted life year (QALY). Missing values were estimated using multiple imputation, bootstrap simulations were performed to address the uncertainty surrounding the incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  There was no difference in average QALYs between the intervention (0.70) and control group (0.72) [difference -0.02 (95% CI -0.05 to 0.10)]. The intervention group, however, was less expensive than the control group (total costs €3636 versus €5267, respectively). Most cost-effectiveness pairs were located in the south-west quadrant of the cost-effectiveness plane, implying the intervention was less effective but also less costly. The ICER of the pooled data was €70,180, meaning that for one QALY lost, €70,180 is saved.
  
  
  CONCLUSIONS
  This study shows that an antidepressant cessation advice given to patients (and their FPs) with inappropriate long-term antidepressant usage, albeit not effective, does seem to result in a reduction of societal costs. This reduction in costs is mostly due to reduction of productivity losses, possibly due to patient empowerment and loss of stigma.
authors.affiliation: Department of Primary and Community Care, rhona.eveleigh@radboudumc.nl.
authors.forename: Rhona
authors.initials: R
authors.lastname: Eveleigh
authors.affiliation: Department for Health Evidence and Department of Operating Rooms, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Grutters
authors.affiliation: Department of Primary and Community Care.
authors.forename: Esther
authors.initials: E
authors.lastname: Muskens
authors.affiliation: University Center for Psychiatry & Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Oude Voshaar
authors.affiliation: Department of Primary and Community Care, Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia, and.
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.affiliation: Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Speckens
authors.affiliation: Department of Primary and Community Care.
authors.forename: Peter
authors.initials: P
authors.lastname: Lucassen
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy; D015709:Correspondence as Topic; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics* / Q000592:standards; D015397:Program Evaluation; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant medication; anxiety; anxiety disorder; depression; health economics.; mood disorder; primary care