The Cost Effectiveness of Maintenance Cognitive Behavioral Therapy of Major Depression in the Netherlands

Posted: 17 Jun 2007

See all articles by Pieter van Baal

Pieter van Baal

Government of the Netherlands - National Institute for Public Health & the Environment

Matthijs van den Berg

National Institute for Public Health & the Environment

Sylvia Vijgen

National Institute for Public Health & the Environment

Theo Vos

University of Queensland

Abstract

Background In the Netherlands, the twelvemonth prevalence of major depression is estimated at 737,000 (i.e. 5.4% of those above 12 years of age). For depression, the two-year risk of recurrence is 40%, and the lifetime risk of recurrence is even 70-80%, which explains why currently depression is considered as a chronic disease rather than an episodic disease. In this respect, the treatment of depression should not only be aimed at the treatment of the specific episode, but also at the prevention of recurrences.

Objective To estimate the cost effectiveness of maintenance cognitive behavioral therapy (MCBT) for people diagnosed with major depression in the Netherlands over a 5 year period from a health care perspective. The setting is the Dutch general practitioner (GP), and costs and effects of MCBT are compared to the cost and effects of usual care by the GP which consists in 80% of antidepressants.

Methods A Markov model was developed distinguishing depressed and undepressed states in which recovery and relapse probabilities are dependent on the time spent in state. Transition probabilities and effectiveness estimates were taken from the study from Vos et al. conducted in Australia. Costs and definition of usual care were adapted to the Dutch situation. Since we had no empirical data on the initial distribution of all people diagnosed with depression by the GP over all model states, we generated this distribution by running the model for a cohort of persons just recovered from an episode. Incremental cost effectiveness ratios (ICER) expressed in euros per DALY averted were estimated by comparing MCBT to usual care over a period of five years. Costs were discounted at 4% and effects at 1.5%. Probabilistic sensitivity analysis was performed to reflect uncertainty in the input parameters of the model.

Results If someone who has just recovered from a depressive episode receives MCBT instead of usual care he/she averts on average about 0.10 DALY over a period of five years at an additional cost of about € 500 resulting in an average cost-effectiveness ratio of €5,000 per DALY averted. In the GP population, the health gains are somewhat lower and a patient on average gains 0.05 DALY over a period of 5 years at higher costs resulting in a mean ICER of € 15,000 per DALY averted. Conclusions The modelling study showed that health gains can be achieved at a relatively low cost if the GP refers persons diagnosed with major depression to MCBT instead of prescribing anti-depressive medication. This is mainly the result of a longer sustained period of risk reduction for recurrence. This conclusion should however be interpreted with caution, since a lot of parameters in the model are based on international studies while some important model parameters, like adherence to treatments, should preferably be based on Dutch data.

Suggested Citation

van Baal, Pieter and van den Berg, Matthijs and Vijgen, Sylvia and Vos, Theo, The Cost Effectiveness of Maintenance Cognitive Behavioral Therapy of Major Depression in the Netherlands. iHEA 2007 6th World Congress: Explorations in Health Economics Paper, Available at SSRN: https://ssrn.com/abstract=994744

Pieter Van Baal (Contact Author)

Government of the Netherlands - National Institute for Public Health & the Environment ( email )

3720 BA Bilthoven
Netherlands
+31 (0)30 274 3152 (Phone)

Matthijs Van den Berg

National Institute for Public Health & the Environment ( email )

3720 BA Bilthoven
Netherlands

Sylvia Vijgen

National Institute for Public Health & the Environment ( email )

3720 BA Bilthoven
Netherlands

Theo Vos

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

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