Cost-effectiveness of treatments for adolescent depression: Results from TADS

Marisa Elena Domino, Barbara J. Burns, Susan G. Silva, Christopher J. Kratochvil, Benedetto Vitiello, Mark A. Reinecke, Jeremy Mario, John S. March

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Objective: While the evidence base for treatments for adolescent depression is building, little is known about the relative efficiency of such treatments. Treatment costs are a relevant concern given the competing demands on family and health care budgets. The authors evaluated the cost-effectiveness of three active treatments among adolescents with major depressive disorder. Method: Volunteers (N=439) ages 12 to 18 with a primary diagnosis of major depressive disorder participated in a randomized, controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Subjects included those participants who did not drop out and had evaluable outcome and cost data at 12 weeks (N=369). Subjects were randomly assigned to 12 weeks of either fluoxetine alone (10-40 mg/day), CBT alone, CBT combined with fluoxetine (10-40 mg/day), or placebo (equivalent to 10-40 mg/day). Both placebo and fluoxetine were administered double-blind; CBT alone and CBT in combination with fluoxetine were administered unblinded. Societal cost per unit of improvement on the Children's Depression Rating Scale - Revised and cost per quality-adjusted life year (QALY) were compared. Results: Results ranged from an incremental cost over placebo of $24,000 per QALY for treatment with fluoxetine to $123,000 per QALY for combination therapy treatment. The cost-effectiveness ratio for CBT treatment was not evaluable due to negative clinical effects. The models were robust on a variety of assumptions. Conclusions: Both fluoxetine and combination therapy are at least as cost-effective in the short-term as other treatments commonly used in primary care (using a threshold of $125,000/QALY). Fluoxetine is more cost-effective than combination therapy after 12 weeks of treatment.

Original languageEnglish (US)
Pages (from-to)588-596
Number of pages9
JournalAmerican Journal of Psychiatry
Volume165
Issue number5
DOIs
StatePublished - May 1 2008

Fingerprint

Cost-Benefit Analysis
Fluoxetine
Depression
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Placebos
Major Depressive Disorder
Family Health
Budgets
Health Care Costs
Volunteers
Primary Health Care
Randomized Controlled Trials
Delivery of Health Care

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Domino, M. E., Burns, B. J., Silva, S. G., Kratochvil, C. J., Vitiello, B., Reinecke, M. A., ... March, J. S. (2008). Cost-effectiveness of treatments for adolescent depression: Results from TADS. American Journal of Psychiatry, 165(5), 588-596. https://doi.org/10.1176/appi.ajp.2008.07101610

Cost-effectiveness of treatments for adolescent depression : Results from TADS. / Domino, Marisa Elena; Burns, Barbara J.; Silva, Susan G.; Kratochvil, Christopher J.; Vitiello, Benedetto; Reinecke, Mark A.; Mario, Jeremy; March, John S.

In: American Journal of Psychiatry, Vol. 165, No. 5, 01.05.2008, p. 588-596.

Research output: Contribution to journalArticle

Domino, ME, Burns, BJ, Silva, SG, Kratochvil, CJ, Vitiello, B, Reinecke, MA, Mario, J & March, JS 2008, 'Cost-effectiveness of treatments for adolescent depression: Results from TADS', American Journal of Psychiatry, vol. 165, no. 5, pp. 588-596. https://doi.org/10.1176/appi.ajp.2008.07101610
Domino, Marisa Elena ; Burns, Barbara J. ; Silva, Susan G. ; Kratochvil, Christopher J. ; Vitiello, Benedetto ; Reinecke, Mark A. ; Mario, Jeremy ; March, John S. / Cost-effectiveness of treatments for adolescent depression : Results from TADS. In: American Journal of Psychiatry. 2008 ; Vol. 165, No. 5. pp. 588-596.
@article{e17fb8a4b07244f695d32814147a425e,
title = "Cost-effectiveness of treatments for adolescent depression: Results from TADS",
abstract = "Objective: While the evidence base for treatments for adolescent depression is building, little is known about the relative efficiency of such treatments. Treatment costs are a relevant concern given the competing demands on family and health care budgets. The authors evaluated the cost-effectiveness of three active treatments among adolescents with major depressive disorder. Method: Volunteers (N=439) ages 12 to 18 with a primary diagnosis of major depressive disorder participated in a randomized, controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Subjects included those participants who did not drop out and had evaluable outcome and cost data at 12 weeks (N=369). Subjects were randomly assigned to 12 weeks of either fluoxetine alone (10-40 mg/day), CBT alone, CBT combined with fluoxetine (10-40 mg/day), or placebo (equivalent to 10-40 mg/day). Both placebo and fluoxetine were administered double-blind; CBT alone and CBT in combination with fluoxetine were administered unblinded. Societal cost per unit of improvement on the Children's Depression Rating Scale - Revised and cost per quality-adjusted life year (QALY) were compared. Results: Results ranged from an incremental cost over placebo of $24,000 per QALY for treatment with fluoxetine to $123,000 per QALY for combination therapy treatment. The cost-effectiveness ratio for CBT treatment was not evaluable due to negative clinical effects. The models were robust on a variety of assumptions. Conclusions: Both fluoxetine and combination therapy are at least as cost-effective in the short-term as other treatments commonly used in primary care (using a threshold of $125,000/QALY). Fluoxetine is more cost-effective than combination therapy after 12 weeks of treatment.",
author = "Domino, {Marisa Elena} and Burns, {Barbara J.} and Silva, {Susan G.} and Kratochvil, {Christopher J.} and Benedetto Vitiello and Reinecke, {Mark A.} and Jeremy Mario and March, {John S.}",
year = "2008",
month = "5",
day = "1",
doi = "10.1176/appi.ajp.2008.07101610",
language = "English (US)",
volume = "165",
pages = "588--596",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "5",

}

TY - JOUR

T1 - Cost-effectiveness of treatments for adolescent depression

T2 - Results from TADS

AU - Domino, Marisa Elena

AU - Burns, Barbara J.

AU - Silva, Susan G.

AU - Kratochvil, Christopher J.

AU - Vitiello, Benedetto

AU - Reinecke, Mark A.

AU - Mario, Jeremy

AU - March, John S.

PY - 2008/5/1

Y1 - 2008/5/1

N2 - Objective: While the evidence base for treatments for adolescent depression is building, little is known about the relative efficiency of such treatments. Treatment costs are a relevant concern given the competing demands on family and health care budgets. The authors evaluated the cost-effectiveness of three active treatments among adolescents with major depressive disorder. Method: Volunteers (N=439) ages 12 to 18 with a primary diagnosis of major depressive disorder participated in a randomized, controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Subjects included those participants who did not drop out and had evaluable outcome and cost data at 12 weeks (N=369). Subjects were randomly assigned to 12 weeks of either fluoxetine alone (10-40 mg/day), CBT alone, CBT combined with fluoxetine (10-40 mg/day), or placebo (equivalent to 10-40 mg/day). Both placebo and fluoxetine were administered double-blind; CBT alone and CBT in combination with fluoxetine were administered unblinded. Societal cost per unit of improvement on the Children's Depression Rating Scale - Revised and cost per quality-adjusted life year (QALY) were compared. Results: Results ranged from an incremental cost over placebo of $24,000 per QALY for treatment with fluoxetine to $123,000 per QALY for combination therapy treatment. The cost-effectiveness ratio for CBT treatment was not evaluable due to negative clinical effects. The models were robust on a variety of assumptions. Conclusions: Both fluoxetine and combination therapy are at least as cost-effective in the short-term as other treatments commonly used in primary care (using a threshold of $125,000/QALY). Fluoxetine is more cost-effective than combination therapy after 12 weeks of treatment.

AB - Objective: While the evidence base for treatments for adolescent depression is building, little is known about the relative efficiency of such treatments. Treatment costs are a relevant concern given the competing demands on family and health care budgets. The authors evaluated the cost-effectiveness of three active treatments among adolescents with major depressive disorder. Method: Volunteers (N=439) ages 12 to 18 with a primary diagnosis of major depressive disorder participated in a randomized, controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Subjects included those participants who did not drop out and had evaluable outcome and cost data at 12 weeks (N=369). Subjects were randomly assigned to 12 weeks of either fluoxetine alone (10-40 mg/day), CBT alone, CBT combined with fluoxetine (10-40 mg/day), or placebo (equivalent to 10-40 mg/day). Both placebo and fluoxetine were administered double-blind; CBT alone and CBT in combination with fluoxetine were administered unblinded. Societal cost per unit of improvement on the Children's Depression Rating Scale - Revised and cost per quality-adjusted life year (QALY) were compared. Results: Results ranged from an incremental cost over placebo of $24,000 per QALY for treatment with fluoxetine to $123,000 per QALY for combination therapy treatment. The cost-effectiveness ratio for CBT treatment was not evaluable due to negative clinical effects. The models were robust on a variety of assumptions. Conclusions: Both fluoxetine and combination therapy are at least as cost-effective in the short-term as other treatments commonly used in primary care (using a threshold of $125,000/QALY). Fluoxetine is more cost-effective than combination therapy after 12 weeks of treatment.

UR - http://www.scopus.com/inward/record.url?scp=43949095804&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=43949095804&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.2008.07101610

DO - 10.1176/appi.ajp.2008.07101610

M3 - Article

C2 - 18413703

AN - SCOPUS:43949095804

VL - 165

SP - 588

EP - 596

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 5

ER -