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Brief CBT Cost-Effective for Teens Who Opt Out of Antidepressant Therapy

January 19, 2018

By Megan Brooks

NEW YORK—Brief cognitive behavioral therapy (CBT) delivered in primary care is a cost-effective option for depressed adolescents who decline or quickly stop antidepressant medication, according to an economic analysis of a randomized controlled trial.

Adolescent depression is most often treated in primary care settings with antidepressants, but many families will decline to start an antidepressant for their child or stop treatment before it begins to work adequately.

In a randomized controlled trial published in 2016 in Pediatrics (http://bit.ly/2Dlodwk), researchers from Kaiser Permanente Center for Health Research in Portland, Oregon, found that brief individual CBT delivered in primary care by qualified therapists reduced depressive symptoms better than treatment-as-usual (TAU) in adolescents with an incident episode of depression who either refused or quickly went off antidepressant medication. The trial involved 212 adolescents aged 12 to 18.

In a paper online January 19 in the same journal, the researchers now report results of cost-effectiveness analysis of the trial.

CBT had a “significant” advantage over TAU in terms of depression-free days and quality-adjusted life-years (QALYs) over 12 months of follow-up and CBT surpassed TAU by 24 months follow-up, as evidenced by a “statistically significant cost offset,” they report.

Over 12 months, adolescents who received CBT had 26.8 more depression-free days (P=0.044) and 0.067 more QALYs (P=0.044), on average, compared with adolescents who received TAU. Across the full 24-month follow-up period, adolescents who received CBT had an additional 43.3 depression-free days, on average, compared with their TAU peers.

Total costs per depression-free day were $51 and $115 lower at 12 and 24 months, respectively, with CBT, and total costs per QALY were $20,282 and $45,792 lower, the researchers report.

They say all of their estimates, including sensitivity analyses, fell well below the generally accepted cost-per-QALY threshold of $50,000.

This analysis “provides additional evidence that CBT is effective at reducing depression symptoms among kids who either choose not to take antidepressants or quickly stop using them, and the economic evaluation demonstrates that this is likely a highly cost-effective treatment option,” first author Dr. John Dickerson said in a phone interview with Reuters Health.

Based on the analysis, it appears the CBT intervention may be cost-neutral in the first year and cost-saving by the end of the second year, the researchers report. “It appears it is not a cost-burden on a healthcare system,” said Dr. Dickerson.

The researchers note that the CBT intervention had a “low” number of sessions relative to typically delivered CBT (maximum, 9 sessions; median, 7), which resulted in a lower cost relative to other CBT interventions, possibly contributing to the more favorable cost outcomes. They say they chose to test this “lean” model because it was more likely to be adopted in the healthcare organization.

“These results are relatively new, but we are trying to make them available to Kaiser and other organizations that are looking to improve care,” Dr. Dickerson told Reuters Health.

SOURCE: http://bit.ly/2EVlqXV

Pediatrics 2018.

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