Publication

Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

Klein, N. S., Wijnen, B. F. M., Lokkerbol, J., Buskens, E., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Dekker, J., de Jong, P. J., Nolen, W. A., Schene, A. H., Hollon, S. D., Burger, H. & Bockting, C. L. H., Jan-2019, In : BJPsych Open. 5, 1, 9 p., e12.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Klein, N. S., Wijnen, B. F. M., Lokkerbol, J., Buskens, E., Elgersma, H. J., van Rijsbergen, G. D., ... Bockting, C. L. H. (2019). Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. BJPsych Open, 5(1), [e12]. https://doi.org/10.1192/bjo.2018.81

Author

Klein, Nicola S. ; Wijnen, Ben F. M. ; Lokkerbol, Joran ; Buskens, Erik ; Elgersma, Hermien J. ; van Rijsbergen, Gerard D. ; Slofstra, Christien ; Ormel, Johan ; Dekker, Jack ; de Jong, Peter J. ; Nolen, Willem A. ; Schene, Aart H. ; Hollon, Steven D. ; Burger, Huibert ; Bockting, Claudi L. H. / Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. In: BJPsych Open. 2019 ; Vol. 5, No. 1.

Harvard

Klein, NS, Wijnen, BFM, Lokkerbol, J, Buskens, E, Elgersma, HJ, van Rijsbergen, GD, Slofstra, C, Ormel, J, Dekker, J, de Jong, PJ, Nolen, WA, Schene, AH, Hollon, SD, Burger, H & Bockting, CLH 2019, 'Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants', BJPsych Open, vol. 5, no. 1, e12. https://doi.org/10.1192/bjo.2018.81

Standard

Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. / Klein, Nicola S.; Wijnen, Ben F. M.; Lokkerbol, Joran; Buskens, Erik; Elgersma, Hermien J.; van Rijsbergen, Gerard D.; Slofstra, Christien; Ormel, Johan; Dekker, Jack; de Jong, Peter J.; Nolen, Willem A.; Schene, Aart H.; Hollon, Steven D.; Burger, Huibert; Bockting, Claudi L. H.

In: BJPsych Open, Vol. 5, No. 1, e12, 01.2019.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Klein NS, Wijnen BFM, Lokkerbol J, Buskens E, Elgersma HJ, van Rijsbergen GD et al. Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. BJPsych Open. 2019 Jan;5(1). e12. https://doi.org/10.1192/bjo.2018.81


BibTeX

@article{2d6b9677b93d4345afbefdb4d702518a,
title = "Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants",
abstract = "BACKGROUND: As depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/-AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.METHOD: Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.RESULTS: Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/-AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/-AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/-AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/-AD.CONCLUSIONS: Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/-AD will become cost-effective.Declaration of interestC.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.",
author = "Klein, {Nicola S.} and Wijnen, {Ben F. M.} and Joran Lokkerbol and Erik Buskens and Elgersma, {Hermien J.} and {van Rijsbergen}, {Gerard D.} and Christien Slofstra and Johan Ormel and Jack Dekker and {de Jong}, {Peter J.} and Nolen, {Willem A.} and Schene, {Aart H.} and Hollon, {Steven D.} and Huibert Burger and Bockting, {Claudi L. H.}",
year = "2019",
month = "1",
doi = "10.1192/bjo.2018.81",
language = "English",
volume = "5",
journal = "BJPsych Open",
issn = "2056-4724",
publisher = "ROYAL COLL PSYCHIATRISTS",
number = "1",

}

RIS

TY - JOUR

T1 - Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

AU - Klein, Nicola S.

AU - Wijnen, Ben F. M.

AU - Lokkerbol, Joran

AU - Buskens, Erik

AU - Elgersma, Hermien J.

AU - van Rijsbergen, Gerard D.

AU - Slofstra, Christien

AU - Ormel, Johan

AU - Dekker, Jack

AU - de Jong, Peter J.

AU - Nolen, Willem A.

AU - Schene, Aart H.

AU - Hollon, Steven D.

AU - Burger, Huibert

AU - Bockting, Claudi L. H.

PY - 2019/1

Y1 - 2019/1

N2 - BACKGROUND: As depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/-AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.METHOD: Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.RESULTS: Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/-AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/-AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/-AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/-AD.CONCLUSIONS: Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/-AD will become cost-effective.Declaration of interestC.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.

AB - BACKGROUND: As depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/-AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.METHOD: Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.RESULTS: Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/-AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/-AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/-AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/-AD.CONCLUSIONS: Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/-AD will become cost-effective.Declaration of interestC.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.

U2 - 10.1192/bjo.2018.81

DO - 10.1192/bjo.2018.81

M3 - Article

VL - 5

JO - BJPsych Open

JF - BJPsych Open

SN - 2056-4724

IS - 1

M1 - e12

ER -

ID: 75453732