Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents.
OBJECTIVE: To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to 'current practice'. METHOD...
| Publicado en: | Australian & New Zealand Journal of Psychiatry Vol. 38; no. 8; pp. 579 - 592 |
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| Autores principales: | , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Aug2004
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106547900&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106547900 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00048674 7ZU jtl: Australian & New Zealand Journal of Psychiatry issn: 00048674 maglogo: Y pubinfo: dt: Aug2004 vid: 38 iid: 8 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 106547900 106547900 2009062419 10.1080/j.1440-1614.2004.01421.x NLM15298580 106547900 ppf: 579 ppct: 13 formats: fmt: @attributes: type: P tig: atl: Cost-effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents. aug: au: Haby MM Tonge B Littlefield L Carter R Vos T affil: Senior Epidemiologist, Health Surveillance and Evaluation Section, Public Health, Department of Human Services, Melbourne, Australia; michelle.haby@dhs.vic.gov.au sug: subj: Cognitive Therapy Economics Depression Drug Therapy Depression Economics Depression Therapy Serotonin Uptake Inhibitors Economics Adolescence Australia Child Cognitive Therapy Evaluation Confidence Intervals Cost Benefit Analysis Descriptive Statistics Female Male Odds Ratio P-Value Patient Compliance Serotonin Uptake Inhibitors Administration and Dosage Human Adolescent: 13-18 years Child: 6-12 years Female Male ab: OBJECTIVE: To assess from a health sector perspective the incremental cost-effectiveness of cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of major depressive disorder (MDD) in children and adolescents, compared to 'current practice'. METHOD: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analysis of randomised controlled trials. An assessment on second stage filter criteria ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are tracked for the duration of a new episode of MDD arising in eligible children (age 6-17 years) in the Australian population in the year 2000. Simulation-modelling techniques are used to present a 95% uncertainty interval (UI) around the cost-effectiveness ratios. RESULTS: Compared to current practice, CBT by public psychologists is the most cost-effective intervention for MDD in children and adolescents at A$9000 per DALY saved (95% UI A$3900 to A$24 000). SSRIs and CBT by other providers are less cost-effective but likely to be less than A$50 000 per DALY saved (> 80% chance). CBT is more effective than SSRIs in children and adolescents, resulting in a greater total health benefit (DALYs saved) than could be achieved with SSRIs. Issues that require attention for the CBT intervention include equity concerns, ensuring an adequate workforce, funding arrangements and acceptability to various stakeholders. CONCLUSIONS: Cognitive behavioural therapy provided by a public psychologist is the most effective and cost-effective option for the first-line treatment of MDD in children and adolescents. However, this option is not currently accessible by all patients and will require change in policy to allow more widespread uptake. It will also require 'start-up' costs and attention to ensuring an adequate workforce. pubtype: Academic Journal doctype: research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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