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Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline

Health Economics Research Centre, Department of Public Health, University of Oxford and National Collaborating Centre for Mental Health (NCCMH), Centre for Outcomes, Research and Effectiveness, Sub-department of Clinical Psychology, University College London

Stephen Pilling, MSc, NCCMH

Centre for Outcomes, Research and Effectiveness, Sub-department of Clinical Psychology, University College London and Camden and Islington Mental Health and Social Care Trust, London

Rachel Burbeck, MSc, NCCMH

Royal College of Psychiatrists’ Research Unit, London

David Goldberg, MD, FRCP

Institute of Psychiatry, King’s College, London, UK

Correspondence: Dr Judit Simon, Health Economics Research Centre, Old Road Campus, Headington, Oxford OX3 7LF, UK. Tel: +44 (0) 1865 226692; fax: +44 (0) 1865 226842; email: judit.simon{at}dphpc.ox.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Treatment options for depression include antidepressants, psychological therapy and a combination of the two.

Aims To develop cost-effective clinical guidelines.

Method Systematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.

Results Over the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI1400–18300); the cost per quality-adjusted life year gained was £5777 (95% CI1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.

Conclusions Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

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