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Institute of Psychiatry, London
Centre for Health Economics, University of York
Department of Psychiatry, University of Cambridge
MRC Cognition and Brain Sciences Unit, Cambridge
Department of Psychiatry, University of Cambridge, UK
Correspondence: Jan Scott, PO Box 96, Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail: j.scott{at}iop.kcl.ac.uk
Declaration of interest This research was supported by a grant from the Medical Research Council.
Background There is a lack of data on the cost-effectiveness of relapse prevention in depression.
Method A total of 158 subjects with partially remitted major depression despite adequate clinical treatment were randomly allocated to cognitive therapy in addition to antidepressants and clinical management v. antidepressants and clinical management alone. Relapse rates and health care resource utilisation were measured prospectively over 17 months.
Results Cumulative relapse rates in the cognitive therapy group were significantly lower than in the control group (29% v. 47%). The incremental cost incurred in subjects receiving cognitive therapy over 17 months (£779; 95% CI £387-£1170) was significantly lower than the overall mean costs of cognitive therapy (£1164; 95% CI £1084-£1244). The incremental cost-effectiveness ratio ranged from £4328 to £5027 per additional relapse prevented.
Conclusions In individuals with depressive symptoms that are resistant to standard treatment, adjunctive cognitive therapy is more costly but more effective than intensive clinical treatment alone.
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