Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the tads randomized trial

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

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46 Scopus citations

Abstract

OBJECTIVE:: The cost-effectiveness of three active interventions for major depression in adolescents was compared after 36 weeks of treatment in the Treatment of Adolescents with Depression Study. METHOD:: Outpatients aged 12 to 18 years with a primary diagnosis of major depression participated in a randomized controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Three hundred twenty-seven participants randomized to 1 of 3 active treatment arms, fluoxetine alone (n = 109), cognitive-behavioral therapy (n = 111) alone, or their combination (n = 107), were evaluated for a 3-month acute treatment and a 6-month continuation/maintenance treatment period. Costs of services received for the 36 weeks were estimated and examined in relation to the number of depression-free days and quality-adjusted life-years. Cost-effectiveness acceptability curves were also generated. Sensitivity analyses were conducted to assess treatment differences on the quality-adjusted life-years and cost-effectiveness measures. RESULTS:: Cognitive-behavioral therapy was the most costly treatment component (mean $1,787 [in monotherapy] and $1,833 [in combination therapy], median $1,923 [for both]). Reflecting higher direct and indirect costs associated with psychiatric hospital use, the costs of services received outside Treatment of Adolescents with Depression Study in fluoxetine-treated patients (mean $5,382, median $2,341) were significantly higher than those in participants treated with cognitive-behavioral therapy (mean $3,102, median $1,373) or combination (mean $2,705, median $927). Accordingly, cost-effectiveness acceptability curves indicate that combination treatment is highly likely (>90%) to be more cost-effective than fluoxetine alone at 36 weeks. Cognitive-behavioral therapy is not likely to be more cost-effective than fluoxetine. CONCLUSIONS:: These findings support the use of combination treatment in adolescents with depression over monotherapy.

Original languageEnglish (US)
Pages (from-to)711-720
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume48
Issue number7
DOIs
StatePublished - Jul 2009

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Keywords

  • Antidepressants
  • Cognitive-behavioral therapy
  • Cost-effectiveness
  • Depression

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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