Economic evaluation of St. John's wort (Hypericum perforatum) for the treatment of mild to moderate depression

Solomon, Daniela, Adams, Jon and Graves, Nicholas (2013) Economic evaluation of St. John's wort (Hypericum perforatum) for the treatment of mild to moderate depression. Journal of Affective Disorders, 148 2-3: 228-234. doi:10.1016/j.jad.2012.11.064


Author Solomon, Daniela
Adams, Jon
Graves, Nicholas
Title Economic evaluation of St. John's wort (Hypericum perforatum) for the treatment of mild to moderate depression
Formatted title
Economic evaluation of St.John’s wort (Hypericum perforatum) for the treatment of mild to moderate depression
Journal name Journal of Affective Disorders   Check publisher's open access policy
ISSN 0165-0327
1573-2517
Publication date 2013-06-01
Sub-type Article (original research)
DOI 10.1016/j.jad.2012.11.064
Open Access Status Not yet assessed
Volume 148
Issue 2-3
Start page 228
End page 234
Total pages 7
Place of publication Netherlands
Publisher Elsevier
Language eng
Subject 3203 Clinical Psychology
2738 Psychiatry and Mental health
Abstract Background: The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with Complementary and Alternative Medicines. Clinical controlled trials have found St. John's wort to be as effective as antidepressants in the treatment of mild to moderate depression. The objective of this study was to develop a model to assess the cost-effectiveness of St. John's wort based on this evidence. Methods: A Markov model was constructed to estimate health and economic impacts of St. John's wort versus antidepressants. Outcomes were treatment costs, quality-adjusted life years (QALYs) and Net Monetary Benefits (NMB). Probabilistic analyses were conducted on key model parameters. Results: The average NMB across 5000 simulations identified St. John's wort as the strategy with the highest net benefit. The total cost savings for SJW were $359.66 and $202.56 per individual for venlafaxine and sertraline respectively, with a gain of 0.08 to 0.12 QALYs over the 72 weeks of the model. Limitations: A lack of direct comparative clinical trial data comparing SJW to venlafaxine and limited data with sertraline as a comparator was a major limitation. Conclusions: In this model, St. John's wort was shown to be a cost-effective alternative to generic antidepressants. Patients are more likely to receive treatment for a duration consistent with professional guidelines for treatment of major depression due to reduced incidence of adverse effects, improving outcomes. This represents an important option in the treatment of Major Depressive Disorder.
Formatted abstract
Background The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with Complementary and Alternative Medicines. Clinical controlled trials have found St. John's wort to be as effective as antidepressants in the treatment of mild to moderate depression. The objective of this study was to develop a model to assess the cost-effectiveness of St. John's wort based on this evidence.

Methods A Markov model was constructed to estimate health and economic impacts of St. John's wort versus antidepressants. Outcomes were treatment costs, quality-adjusted life years (QALYs) and Net Monetary Benefits (NMB). Probabilistic analyses were conducted on key model parameters.

Results The average NMB across 5000 simulations identified St. John's wort as the strategy with the highest net benefit. The total cost savings for SJW were $359.66 and $202.56 per individual for venlafaxine and sertraline respectively, with a gain of 0.08 to 0.12 QALYs over the 72 weeks of the model.

Limitations A lack of direct comparative clinical trial data comparing SJW to venlafaxine and limited data with sertraline as a comparator was a major limitation.

Conclusions In this model, St. John's wort was shown to be a cost-effective alternative to generic antidepressants. Patients are more likely to receive treatment for a duration consistent with professional guidelines for treatment of major depression due to reduced incidence of adverse effects, improving outcomes. This represents an important option in the treatment of Major Depressive Disorder.
Keyword Economic evaluation
Depression
St. john's wort
Serotonin reuptake inhibitors
Primary-care patients
Cost-effectiveness
Major depression
Maintenance treatment
Anxiety disorders
Drug-interactions
Mental-disorders
Double-blind
Health
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
 
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