Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive-behavioural therapy in adolescents with major depression
Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive-behavioural therapy in adolescents with major depression
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DOI：
10.1192/bjp.bp.107.038984
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发表时间：
2007-12-01
影响因子：
10.5
通讯作者：
Goodyer, I.
中科院分区：
文献类型：
--
作者：
Byford, S.;Barrett, B.;Goodyer, I.
背景 重度抑郁症是青少年中一个重要且代价高昂的问题，但缺乏支持提供具有成本效益的治疗方法的证据。目的 评估选择性血清素再摄取抑制剂 (SSRI) 和认知行为疗法 (CBT) 联合治疗以及临床护理与单独使用 SSRI 和临床护理治疗重度抑郁症青少年的短期成本效益。方法 在英国进行实用随机对照试验。在基线、12 周和 28 周时评估结果和成本。结果 该试验由 208 名年龄在 11-17 岁之间的青少年组成，他们患有重度或可能重度抑郁症，对简短的初始心理社会干预没有反应。有和没有 CBT 的组之间的结果没有显着差异。 CBT 组的成本较高，但差异并不显着 (P=0.057)。成本效益分析和对相关不确定性的探索表明，CBT 加 SSRIs 比单独使用 SSRIs 更具成本效益的可能性不到 30%。结论 对于接受常规专科临床护理的重度抑郁症青少年来说，短期内 CBT 联合 SSRI 的组合并不比单独使用 SSRI 更具成本效益。
Background Major depression is an important and costly problem among adolescents, yet evidence to support the provision of cost-effective treatments is lacking. Aims To assess the short-term cost-effectiveness of combined selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioural therapy (CBT) together with clinical care compared with SSRIs and clinical care alone in adolescents with major depression. Method Pragmatic randomised controlled trial in the UK. Outcomes and costs were assessed at baseline, 12 and 28 weeks. Results The trial comprised 208 adolescents, aged 11-17 years, with major or probable major depression who had not responded to a brief initial psychosocial intervention. There were no significant differences in outcome between the groups with and without CBT. Costs were higher in the group with CBT, although not significantly so (P=0.057). Cost-effectiveness analysis and exploration of the associated uncertainty suggest there is less than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs alone. Conclusions A combination of CBT plus SSRIs is not more cost-effective in the short-term than SSRIs alone for treating adolescents with major depression in receipt of routine specialist clinical care.