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

dc.contributor.authorHollon, Steven D.
dc.identifier.citationKlein, N. S., Wijnen, B., 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. (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.
dc.descriptionOnly Vanderbilt University affiliated authors are listed on VUIR. For a full list of authors, access the version of record at
dc.description.abstractBackground As depression has a recurrent course, relapse and recurrence prevention is essential. Aims In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT)to maintenance anti-depressants (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 (sic)6814, (sic)10 264 and (sic)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.en_US
dc.description.sponsorshipThe current study was sponsored by the Netherlands Organisation for Health Research and Development (ZONMW) (171002401). In addition, C.L.H.B. worked on this manuscript during a fellowship at the Netherlands Institute for Advanced study in the Humanities and Social Sciences, supported by the Royal Netherlands Academy of Arts and Sciences.en_US
dc.publisherBJPsych Openen_US
dc.rightsCopyright © The Royal College of Psychiatrists 2019 This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
dc.subjectDepressive disordersen_US
dc.subjectcognitive behavioural therapiesen_US
dc.titleCost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressantsen_US

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