番茄社区

The cost-effectiveness of first-line depression treatment depends on the analysis's timeframe, a new study found.

In an analysis led by Eric Ross, MD, of Massachusetts General Hospital in Boston, and colleagues, and published in , cognitive behavioral therapy (CBT) got a slight edge as being more cost-effective over time.

After one year, costs were higher with CBT versus second-generation antidepressants: about $900 more in medical costs and $1,500 more in societal costs. After five years of treatment, though, CBT yielded lower costs compared to antidepressant treatment, with $1,800 less in healthcare costs and $2,500 less in societal costs.

In the projected analysis, Ross's group also found that CBT produced slightly more quality adjusted life-years than second-generation antidepressants, yielding 3 more days with one year of treatment and 20 more days five years into treatment.

With a five-year horizon, CBT was projected to be the preferred strategy of depression treatment for producing the greatest net monetary benefit, with around 75% likelihood. With only one year of treatment, though, a second-generation antidepressant was more likely to be the preferred strategy with about 71% certainty.

According to -- which do not expressly take cost into account -- treatment with a second-generation antidepressant -- such as SSRIs, SNRIs, and atypical antidepressants -- or cognitive behavioral therapy have similar efficacy and relapse rates for managing major depressive disorder (MDD).

"If I'd had to guess before starting our study, I would've expected to find that CBT isn't cost-effective relative to antidepressants -- simply because antidepressants are so much cheaper than psychotherapy," Ross explained to 番茄社区. "So it was a surprise to find that the two treatments are about equivalent in terms of cost-effectiveness."

"The big takeaway for clinicians is that for initial treatment of depression, both CBT and antidepressants are reasonable treatment options. You can't discount either of them on the basis of cost-effectiveness," he pointed out. "I think of this as clearing the way for all of the other factors that go into shared decision-making -- patient values and preferences, clinician experience, availability of providers, convenience, etc. -- to really take center stage in guiding treatment decisions."

For the analysis, the researcher used average costs for each treatment method during 2017 in the U.S. Projected healthcare sector costs included first medical costs, such as physician visits (averaging $74), medication costs, as well as individual and group psychotherapies (averaging $128 and $26, respectively). Societal costs encompassed both patient time -- averaged at about $27 per hour -- and productivity losses.

Other types of first-line major depression treatment options, such as combined treatments, alternative medicine, and other psychotherapies were not included in the analysis.

In an , Mark Sinyor, MSc, MD of the University of Toronto, underscored that these findings should be "interpreted cautiously."

"They rely on modeling based on many assumptions about the delivery, effectiveness, and tolerability of both CBT and SGAs [second-generation antidepressants] that may not adequately approximate real-world conditions in different regions of the United States or internationally," he explained. Sinyor continued, pointing out how the analysis was limited by the exclusion of combination treatments, which he says is "likely superior to either CBT or SGAs alone in severe MDD."

He also added that certain patients may only respond to CBT and not antidepressants, vise versa, or may only respond to both treatments. Sinyor thus agreed with Ross, advocating for individualized patient treatment, but he also emphasized that CBT "must become equally available" relative to drug therapy for there to be a true choice.

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