Cost-Efficacy

Bosmans, J. E., van Schaik, D. J. F., de Bruijne, M. C., van Hout, H. P. J., van Marwijk, H. W. J., van Tulder, M. W., & Stalman, W. A. B. (2008). Are psychological treatments for depression in primary care cost-effective? Journal of Mental Health Policy and Economics, 11(1) 3-15.

Correspondence Address:
Correspondence Address Judith E. Bosmans, VU University, Faculty of Earth and Life Sciences, Institute for Health Sciences, De Boelelaan 1085, Amsterdam, Netherlands, 1081 HV, judith.bosmans@falw.vu.nl.

Abstract
Background: Depression is a highly prevalent condition that is associated with high levels of work absenteeism and high health care costs. Most patients are treated in primary care. A large group of patients prefers psychological treatments to antidepressants. Aims of the Study: To systematically review the evidence for the cost-effectiveness of psychological treatments, psychotherapy and counselling, in comparison with usual care or antidepressant treatment in adult primary care patients with depression. Methods: A computer-assisted search of MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library was carried out. Two independent reviewers selected studies for the review, extracted data and assessed the methodological quality of the included studies. Results: Seven studies were included in the review. Forms of psychotherapy that were evaluated were cognitive behavioural therapy, interpersonal psychotherapy and couple therapy. Usual care generally consisted of care as usually provided by the general practitioner. No conclusion can be drawn on the cost-effectiveness of the above mentioned forms of psychotherapy in comparison with usual care or antidepressant treatment. The cost-effectiveness of counselling in comparison with usual care and antidepressant therapy is yet to be established. Meta-analyses showed that psychotherapy was significantly more expensive than usual care, but not significantly more expensive than antidepressant treatment. Counselling was associated with no statistically significant differences in costs and effects in comparison with usual care in the pooled analysis. Discussion: Based on this review, no firm conclusions on the cost-effectiveness of psychotherapy and counselling in primary care can be drawn. Most studies had methodological shortcomings, which limit the generalisibility of the results. Implications for Health Policies: Given the reluctance of patients to use antidepressants and the large economic impact of depression, policy makers have a need for well designed and sufficiently powered economic evaluations of psychological treatments. The available evidence seems to indicate that psychotherapy has more substantial clinical effects than counselling. Therefore, the emphasis should be on economic evaluations of forms of psychotherapy that have proved to be clinically effective. Implications for Further Research: There are indications that the cost-effectiveness of depression treatment on the whole may be improved by incorporating psychological treatments into enhanced care models, tailored to the needs of individual patients and/or by providing them by trained nurses instead of psychologists or psychotherapists. Further research should investigate these patient tailored, stepped care treatment modalities for depression treatment. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

McHugh, R. K., Otto, M. W., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2007). Cost-efficacy of individual and combined treatments for panic disorder. Journal of Clinical Psychiatry, 68(7) 1038-1044.

Correspondence Address:
Correspondence Address R. Kathryn McHugh, Center for Anxiety and Related Disorders, Boston University, 648 Beacon St., 6th Floor, Boston, MA, US, 02215, rkmchugh@bu.edu.

Abstract
Objective: The objective of this study was to examine the relative cost-efficacy of empirically supported treatments for panic disorder. As psychosocial, pharmacologic, and combined treatments have all demonstrated efficacy in the treatment of panic disorder, cost-efficacy analysis provides an additional source of information to guide clinical decision making. Method: Cost-efficacy was examined based on results from the Multicenter Comparative Treatment Study of Panic Disorder, a randomized controlled trial of treatment for panic disorder (DSM-III-R). The trial was conducted from May 1991 to April 1998. Cost-efficacy ratios representing the cost per 1-unit improvement in Panic Disorder Severity Scale mean item score were calculated for 3 monotherapies (cognitive-behavioral therapy [CBT], imipramine, and paroxetine) and 2 combination treatments (CBT-imipramine and CBT-paroxetine) at the end of acute, maintenance, and follow-up phases. Results: Results demonstrated consistently greater cost-efficacy for individual over combined treatments, with imipramine representing the most cost-efficacious treatment option at the completion of the acute phase (cost-efficacy ratio = $972) and CBT representing the most cost-efficacious option at the end of maintenance treatment (cost efficacy ratio = $1449) and 6 months after treatment termination (cost efficacy ratio = $1227). Conclusion: In the context of similar efficacy for combined treatments, but poorer cost-efficacy, current monotherapies should be considered the first-line treatment of choice for panic disorder. Additionally, CBT emerged as the most durable and cost-effective monotherapy and, hence, should be considered as a particularly valuable treatment from the perspective of cost accountability. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Myhr, G., & Payne, K. (2006). Cost-effectiveness of cognitive-behavioural therapy for mental disorders: Implications for public health care funding policy in Canada. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 51(10) 662-670.

Correspondence Address:
Correspondence Address Gail Myhr, Department of Psychiatry, McGill University Health Centre (Royal Victoria Hospital), 1025 Pine Avenue West, Montreal, PQ, Canada, H3A 1A1, gail.myhr@mcgill.ca.

Abstract
Objective: Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. Method: We searched the literature for economic analyses of CBT in the treatment of mental disorders. Results: We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. Conclusions: International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada. (PsycINFO Database Record (c) 2008 APA, all rights reserved)