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Published in: The European Journal of Health Economics 5/2019

01-07-2019 | Antidepressant Drugs | Original Paper

Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study)

Authors: Maria Rubio-Valera, María Teresa Peñarrubia-María, Maria Iglesias-González, Martin Knapp, Paul McCrone, Marta Roig, Ramón Sabes-Figuera, Juan V. Luciano, Juan M. Mendive, Ana Gabriela Murrugara-Centurión, Jordi Alonso, Antoni Serrano-Blanco

Published in: The European Journal of Health Economics | Issue 5/2019

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Abstract

Background

The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild–moderate major depressive disorder.

Methods

This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners’ clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost–utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used.

Results

At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective).

Conclusions

Incremental cost–utility ratios favor pharmacological treatment as a first-line approach for patients with mild–moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild–moderate major depressive patients as an alternative to active monitoring in PC.
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Metadata
Title
Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study)
Authors
Maria Rubio-Valera
María Teresa Peñarrubia-María
Maria Iglesias-González
Martin Knapp
Paul McCrone
Marta Roig
Ramón Sabes-Figuera
Juan V. Luciano
Juan M. Mendive
Ana Gabriela Murrugara-Centurión
Jordi Alonso
Antoni Serrano-Blanco
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 5/2019
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-019-01034-5

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