Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression: Treatment of SSRI-resistant depression in adolescents trial findings

Frances L. Lynch, John F. Dickerson, Greg Clarke, Benedetto Vitiello, Giovanna Porta, Karen Wagner, Graham Emslie, Joan Rosenbaum Asarnow, Martin B. Keller, Boris Birmaher, Neal D. Ryan, Betsy Kennard, Taryn Mayes, Lynn DeBar, James T. McCracken, Michael Strober, Robert L. Suddath, Anthony Spirito, Matthew Onorato, Jamie ZelaznySatish Iyengar, David Brent

Research output: Contribution to journalArticle

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Abstract

Context: Many youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors (SSRIs), and this is associated with higher costs. More effective treatment for these youth may be cost-effective. Objective: To evaluate the incremental costeffectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI. Design: Randomized controlled trial. Setting: Six US academic and community clinics. Patients: Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression. Intervention: Participants were randomly assigned to (1) switch to a different medication only or (2) switch to a different medication plus cognitive behavior therapy. Main Outcome Measures: Clinical outcomes were depression-free days (DFDs), depression-improvement days (DIDs), and quality-adjusted life-years based on DFDs (DFD-QALYs). Costs of intervention, nonprotocol services, and families were included. Results: Combined treatment achieved 8.3 additional DFDs (P=.03), 0.020 more DFD-QALYs (P=.03), and 11.0 more DIDs (P=.04). Combined therapy cost $1633 more (P=.01). Cost per DFD was $188 (incremental cost-effectiveness ratio [ICER]=$188; 95% confidence interval [CI], -$22 to $1613), $142 per DID (ICER=$142; 95% CI, -$14 to $2529), and $78 948 per DFD-QALY (ICER=$78 948; 95% CI, -$9261 to $677 448). Cost-effectiveness acceptability curve analyses suggest a 61% probability that combined treatment is more costeffective at a willingness to pay $100 000 per QALY. Combined treatment had a higher net benefit for subgroups of youth without a history of abuse, with lower levels of hopelessness, and with comorbid conditions. Conclusions: For youth with SSRI-resistant depression, combined treatment decreases the number of days with depression and is more costly. Depending on a decision maker's willingness to pay, combined therapy may be cost-effective, particularly for some subgroups. Trial Registration: clinicaltrials.gov Identifier: NCT00018902.

Original languageEnglish (US)
Pages (from-to)253-262
Number of pages10
JournalArchives of General Psychiatry
Volume68
Issue number3
DOIs
StatePublished - Mar 2011

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Treatment-Resistant Depressive Disorder
Serotonin Uptake Inhibitors
Cost-Benefit Analysis
Depression
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Cognitive Therapy
Confidence Intervals

ASJC Scopus subject areas

  • Psychiatry and Mental health

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Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression : Treatment of SSRI-resistant depression in adolescents trial findings. / Lynch, Frances L.; Dickerson, John F.; Clarke, Greg; Vitiello, Benedetto; Porta, Giovanna; Wagner, Karen; Emslie, Graham; Asarnow, Joan Rosenbaum; Keller, Martin B.; Birmaher, Boris; Ryan, Neal D.; Kennard, Betsy; Mayes, Taryn; DeBar, Lynn; McCracken, James T.; Strober, Michael; Suddath, Robert L.; Spirito, Anthony; Onorato, Matthew; Zelazny, Jamie; Iyengar, Satish; Brent, David.

In: Archives of General Psychiatry, Vol. 68, No. 3, 03.2011, p. 253-262.

Research output: Contribution to journalArticle

Lynch, FL, Dickerson, JF, Clarke, G, Vitiello, B, Porta, G, Wagner, K, Emslie, G, Asarnow, JR, Keller, MB, Birmaher, B, Ryan, ND, Kennard, B, Mayes, T, DeBar, L, McCracken, JT, Strober, M, Suddath, RL, Spirito, A, Onorato, M, Zelazny, J, Iyengar, S & Brent, D 2011, 'Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression: Treatment of SSRI-resistant depression in adolescents trial findings', Archives of General Psychiatry, vol. 68, no. 3, pp. 253-262. https://doi.org/10.1001/archgenpsychiatry.2011.9
Lynch, Frances L. ; Dickerson, John F. ; Clarke, Greg ; Vitiello, Benedetto ; Porta, Giovanna ; Wagner, Karen ; Emslie, Graham ; Asarnow, Joan Rosenbaum ; Keller, Martin B. ; Birmaher, Boris ; Ryan, Neal D. ; Kennard, Betsy ; Mayes, Taryn ; DeBar, Lynn ; McCracken, James T. ; Strober, Michael ; Suddath, Robert L. ; Spirito, Anthony ; Onorato, Matthew ; Zelazny, Jamie ; Iyengar, Satish ; Brent, David. / Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression : Treatment of SSRI-resistant depression in adolescents trial findings. In: Archives of General Psychiatry. 2011 ; Vol. 68, No. 3. pp. 253-262.
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T1 - Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression

T2 - Treatment of SSRI-resistant depression in adolescents trial findings

AU - Lynch, Frances L.

AU - Dickerson, John F.

AU - Clarke, Greg

AU - Vitiello, Benedetto

AU - Porta, Giovanna

AU - Wagner, Karen

AU - Emslie, Graham

AU - Asarnow, Joan Rosenbaum

AU - Keller, Martin B.

AU - Birmaher, Boris

AU - Ryan, Neal D.

AU - Kennard, Betsy

AU - Mayes, Taryn

AU - DeBar, Lynn

AU - McCracken, James T.

AU - Strober, Michael

AU - Suddath, Robert L.

AU - Spirito, Anthony

AU - Onorato, Matthew

AU - Zelazny, Jamie

AU - Iyengar, Satish

AU - Brent, David

PY - 2011/3

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N2 - Context: Many youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors (SSRIs), and this is associated with higher costs. More effective treatment for these youth may be cost-effective. Objective: To evaluate the incremental costeffectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI. Design: Randomized controlled trial. Setting: Six US academic and community clinics. Patients: Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression. Intervention: Participants were randomly assigned to (1) switch to a different medication only or (2) switch to a different medication plus cognitive behavior therapy. Main Outcome Measures: Clinical outcomes were depression-free days (DFDs), depression-improvement days (DIDs), and quality-adjusted life-years based on DFDs (DFD-QALYs). Costs of intervention, nonprotocol services, and families were included. Results: Combined treatment achieved 8.3 additional DFDs (P=.03), 0.020 more DFD-QALYs (P=.03), and 11.0 more DIDs (P=.04). Combined therapy cost $1633 more (P=.01). Cost per DFD was $188 (incremental cost-effectiveness ratio [ICER]=$188; 95% confidence interval [CI], -$22 to $1613), $142 per DID (ICER=$142; 95% CI, -$14 to $2529), and $78 948 per DFD-QALY (ICER=$78 948; 95% CI, -$9261 to $677 448). Cost-effectiveness acceptability curve analyses suggest a 61% probability that combined treatment is more costeffective at a willingness to pay $100 000 per QALY. Combined treatment had a higher net benefit for subgroups of youth without a history of abuse, with lower levels of hopelessness, and with comorbid conditions. Conclusions: For youth with SSRI-resistant depression, combined treatment decreases the number of days with depression and is more costly. Depending on a decision maker's willingness to pay, combined therapy may be cost-effective, particularly for some subgroups. Trial Registration: clinicaltrials.gov Identifier: NCT00018902.

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