Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline

Judit Simon, Stephen Pilling, Rachel Burbeck, David Goldberg
2006 British Journal of Psychiatry  
Treatment options for depression include antidepressants, psychological therapy and a combination of the two. Aims To develop cost-effective clinical guidelines. Method Systematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK. Results Over the 15-month analysis period, combination therapy
more » ... sulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression. Conclusions Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.
doi:10.1192/bjp.bp.105.014571 pmid:17139032 fatcat:mc7fso5bcrblvfsawajfgzn6iu