Medication-only Therapy and Combination Therapy Both Cost Effective for Treating Teens with Depression
• Science Update
Treating depressed teenagers with either the antidepressant fluoxetine (Prozac) or a combination of fluoxetine and psychotherapy can be cost effective, according to a recent economic analysis of the NIMH-funded Treatment for Adolescents with Depression Study (TADS). The study was published online ahead of print April 15, 2008, in the American Journal of Psychiatry.
Marisa Elena Domino, Ph.D., of the University of North Carolina at Chapel Hill, and colleagues compared costs associated with each of the trial’s three active treatment groups—fluoxetine only, cognitive behavioral therapy (CBT) only, and a combination of fluoxetine and CBT—to costs associated with a placebo (sugar pill) group during the first 12 weeks of the trial. The researchers studied direct costs of medication and CBT sessions, and other costs outside the trial, such as visits to primary care providers, school-based services, and lost wages associated with caregivers transporting the adolescent to and from services.
Overall, cost was highest for participants in the combination group—a median of $2,832 per participant. Median cost per participant was $2,287 in the CBT-only group, $942 in the fluoxetine-only group, and $841 in the placebo group. Combination therapy was associated with the highest time and travel costs at $762, but medication costs were lower than those associated with the fluoxetine-only group because those in combination treatment tended to take lower doses of the medication. CBT costs for participants in the CBT-only group and participants receiving it as part of combination treatment did not differ.
Combination treatment cost more, but it also was shown to be more effective than the fluoxetine-only treatment in the first 12 weeks, as reported in August 2004. By assigning a monetary value to clinical improvement, the researchers deduced that both the fluoxetine-only treatment and combination treatment were cost-effective choices.
Finally, CBT was not found to be as effective or as cost effective as the other treatment groups in the first 12 weeks of the trial. However, by the end of the 36-week study, response rates in the CBT-only group had essentially caught up with the other two groups. Therefore, the researchers predicted that if long-term costs remain stable, CBT-only may become a cost-effective treatment choice as well.
Domino ME, Burns BJ, Silva SG, Kratochvil CJ, Vitiello B, Reinecke MA, Mario J, March JS. Cost-effectiveness of treatments for adolescent depression: results from TADS. American Journal of Psychiatry. Published online ahead of print April 15, 2008.