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Economic evidence for the clinical management of major depressive disorder: a systematic review and quality appraisal of economic evaluations alongside randomised controlled trials

Published online by Cambridge University Press:  22 June 2016

E. Karyotaki ,
D. Tordrup ,
C. Buntrock ,
R. Bertollini  and
P. Cuijpers
E. Karyotaki*
Affiliation:
Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands EMGO, Institute of Health Care Research, VU Medical Centre, Amsterdam, The Netherlands
D. Tordrup*
Affiliation:
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, University of Utrecht, The Netherlands
C. Buntrock
Affiliation:
Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands EMGO, Institute of Health Care Research, VU Medical Centre, Amsterdam, The Netherlands Division Health Trainings Online, Leuphana University Innovation Incubator, Lüneburg, Germany
R. Bertollini
Affiliation:
Representation to the EU, WHO, Brussels, Belgium
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands EMGO, Institute of Health Care Research, VU Medical Centre, Amsterdam, The Netherlands
*
*Address for correspondence: E. Karyotaki, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected]) and D. Tordrup, Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Box 80082, 3508 TB Utrecht, The Netherlands. (Email: [email protected])
*Address for correspondence: E. Karyotaki, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected]) and D. Tordrup, Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, University of Utrecht, Box 80082, 3508 TB Utrecht, The Netherlands. (Email: [email protected])
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Abstract

Aims.

The aim of this systematic review of economic evaluations alongside randomised controlled trials (RCTs) was to provide a comprehensive overview of the evidence concerning cost-effectiveness analyses of common treatment options for major depression.

Methods.

An existing database was used to identify studies reporting cost-effectiveness results from RCTs. This database has been developed by a systematic literature search in the bibliographic databases of PubMed, PsychINFO, Embase and Cochrane library from database inception to December 2014. We evaluated the quality of economic evaluations using a 10-item short version of the Drummond checklist. Results were synthesised narratively. The risk of bias of the included RCTs was assessed, based on the Cochrane risk of bias assessment tool.

Results.

Fourteen RCTs were included from the 5580 articles screened on titles and abstracts. The methodological quality of the health economic evaluations was relatively high and the majority of the included RCTs had low risk of bias in most of Cochrane items except blinding of participants and personnel. Cognitive behavioural therapy was examined in seven trials as part of a variety of treatment protocols and seems cost-effective compared with pharmacotherapy in the long-term. However cost-effectiveness results for the combination of psychotherapy with pharmacotherapy are conflicting and should be interpreted with caution due to limited comparability between the examined trials. For several treatments, only a single economic evaluation was reported as part of a clinical trial. This was the case for comparisons between different classes of antidepressants, for several types of psychotherapy (behavioural activation, occupational therapy, interpersonal psychotherapy, short-term psychotherapy, psychodynamic psychotherapy, rational emotive behavioural therapy, solution focused therapy), and for transcranial magnetic stimulation v. electroconvulsive therapy. The limited evidence base for these interventions means generalisations, based on economic evaluation alongside clinical trials, cannot easily be made.

Conclusions.

There is some economic evidence underpinning many of the common treatment options for major depression. Wide variability was observed in study outcomes, probably attributable to differences in population, interventions or follow-up periods. For many interventions, only a single economic evaluation alongside clinical trials was identified. Thus, significant economic evidence gaps remain in the area of major depressive disorder.

Keywords

Depressionmood disorders unipolarpsychotherapycognitive therapy
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 5 , October 2017 , pp. 501 - 516
Copyright
Copyright © Cambridge University Press 2016 

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Footnotes

†

These authors share first authorship.

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