Cost-effectiveness analysis for antidepressants and cognitive behavioral therapy for major depression in Thailand

Prukkanone, Benjamas, Vos, Theo, Bertram, Melanie and Lim, Stephen (2012) Cost-effectiveness analysis for antidepressants and cognitive behavioral therapy for major depression in Thailand. Value in Health, 15 1: S3-S8. doi:10.1016/j.jval.2011.11.009


Author Prukkanone, Benjamas
Vos, Theo
Bertram, Melanie
Lim, Stephen
Title Cost-effectiveness analysis for antidepressants and cognitive behavioral therapy for major depression in Thailand
Journal name Value in Health   Check publisher's open access policy
ISSN 1098-3015
1524-4733
Publication date 2012-01-01
Year available 2012
Sub-type Article (original research)
DOI 10.1016/j.jval.2011.11.009
Open Access Status DOI
Volume 15
Issue 1
Start page S3
End page S8
Total pages 6
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Formatted abstract
Objective: To determine the cost-effectiveness of fluoxetine and cognitive-behavioral therapy (CBT) for major depression in Thailand.

Methods:
A microsimulation model was developed to describe the variation in course of disease between individuals. Model inputs included Thai data on disease parameters and costs while impact measures were derived from a systematic review and meta-analysis of the international literature. Fluoxetine as the cheapest antidepressant drug in Thailand was analyzed for treatment of episodes plus a 6-month continuation phase and for maintenance treatment over 5 years of follow-up. CBT was analyzed for episodic treatment and for 5-year maintenance treatment. Results are presented as cost (Thai bahts) per disability-adjusted life-year (DALY) averted, compared with a “do-nothing” scenario.

Results:
The cost-effectiveness ratios of all interventions were below 1 time Thailand’s gross domestic product of 110,000 bahts per capita. The uncertainty ranges around the cost-effectiveness ratios overlap: maintenance treatment with CBT 11,000 bahts per DALY (8,000 –14,000); episodic treatment with CBT 23,000 bahts per DALY (10,000 –36,000); episodic plus continuation drug treatment 33,000 bahts per DALY (26,000 – 44,000); maintenance drug treatment 38,000 bahts per DALY (30,000 – 48,000); and episodic drug treatment 42,000 bahts per DALY (32,000 –57,000).

Conclusions:
CBT and generic fluoxetine are cost-effective treatment options for both episodic and maintenance treatment of major depression in Thailand. Maintenance treatment has the greatest potential of health gain.
Keyword Health economics
Major depressive disorder
Pharmacotherapy
Psychotherapy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
 
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