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)

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 and Antoni Serrano-Blanco
Additional contact information
Maria Rubio-Valera: Parc Sanitari Sant Joan de Déu
María Teresa Peñarrubia-María: Institut Català de la Salut
Maria Iglesias-González: Parc Sanitari Sant Joan de Déu
Martin Knapp: CIBERESP
Paul McCrone: King’s College London
Marta Roig: Parc Sanitari Sant Joan de Déu
Ramón Sabes-Figuera: CIBERESP
Juan V. Luciano: Parc Sanitari Sant Joan de Déu
Juan M. Mendive: Primary Care Prevention and Health Promotion Research Network (RedIAPP)
Ana Gabriela Murrugara-Centurión: Parc Sanitari Sant Joan de Déu
Jordi Alonso: CIBERESP
Antoni Serrano-Blanco: Parc Sanitari Sant Joan de Déu

The European Journal of Health Economics, 2019, vol. 20, issue 5, No 7, 703-713

Abstract: 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.

Keywords: Depression/mood disorder; Antidepressant medication; Primary care; Health economics (search for similar items in EconPapers)
Date: 2019
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DOI: 10.1007/s10198-019-01034-5

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