Cost-effectiveness of treatments for adolescent depression: Results from TADS
Cost-effectiveness of treatments for adolescent depression: Results from TADS
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DOI：
10.1176/appi.ajp.2008.07101610
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发表时间：
2008-05-01
影响因子：
17.7
通讯作者：
March, John S.
中科院分区：
文献类型：
--
作者：
Domino, Marisa Elena;Burns, Barbara J.;March, John S.
目的：尽管治疗青少年抑郁症的证据基础正在建立，但人们对此类治疗的相对有效性知之甚少。鉴于对家庭和保健预算的相互竞争的需求，治疗费用是一个相关的问题。作者评估了三种积极治疗青少年重度抑郁障碍的成本-效果。方法：志愿者(N=439)，年龄12-18岁，初步诊断为重度抑郁障碍，参加了从2000年到2004年在13个美国学术和社区诊所进行的随机对照试验。受试者包括那些没有退出并且在12周时有可评估的结果和成本数据的参与者(N=369)。受试者被随机分配到单独服用氟西汀(10-40 mg/d)、单独服用CBT、CBT联合氟西汀(10-40 mg/d)或安慰剂(相当于10-40 mg/d)的12周。安慰剂和氟西汀均为双盲给药；CBT单独给药和CBT与氟西汀联合给药均为非盲给药。结果：结果：氟西汀治疗的每QALY增加了24,000美元，而联合治疗每QALY增加了123,000美元。由于临床效果不佳，CBT治疗的成本-效果比无法评估。这些模型在各种假设下都是可靠的。结论：氟西汀和联合治疗至少在短期内与初级保健中常用的其他治疗方法一样具有成本效益(使用125,000美元/QALY的阈值)。治疗12周后，氟西汀比联合治疗更具成本效益。
Objective: While the evidence base for treatments for adolescent depression is building, little is known about the relative efficiency of such treatments. Treatment costs are a relevant concern given the competing demands on family and health care budgets. The authors evaluated the cost-effectiveness of three active treatments among adolescents with major depressive disorder.Method: Volunteers (N=439) ages 12 to 18 with a primary diagnosis of major depressive disorder participated in a randomized, controlled trial conducted at 13 U. S. academic and community clinics from 2000 to 2004. Subjects included those participants who did not drop out and had evaluable outcome and cost data at 12 weeks (N=369). Subjects were randomly assigned to 12 weeks of either fluoxetine alone (10-40 mg/day), CBT alone, CBT combined with fluoxetine (10-40 mg/day), or placebo (equivalent to 10-40 mg/day). Both placebo and fluoxetine were administered double-blind; CBT alone and CBT in combination with fluoxetine were administered unblinded. Societal cost per unit of improvement on the Children's Depression Rating Scale-Revised and cost per quality-adjusted life year (QALY) were compared.Results: Results ranged from an incremental cost over placebo of $24,000 per QALY for treatment with fluoxetine to $123,000 per QALY for combination therapy treatment. The cost-effectiveness ratio for CBT treatment was not evaluable due to negative clinical effects. The models were robust on a variety of assumptions.Conclusions: Both fluoxetine and combination therapy are at least as cost-effective in the short-term as other treatments commonly used in primary care (using a threshold of $125,000/QALY). Fluoxetine is more cost-effective than combination therapy after 12 weeks of treatment.