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4 April 2006
Additional psychotherapy involving minimal contact with a therapist appears to reduce the incidence of depression compared with standard care by up to a third, study findings show.
"Not only is the intervention more effective, this economic evaluation indicates that choosing it over usual care alone is likely to be the best treatment option, because there is a 70% probability that the intervention is preferable to usual care when the costs of production losses are included in the analysis," Filip Smit (Free University, Amsterdam, The Netherlands) and colleagues report.
Noting that even under optimal care the burden of depression can only be averted in about a quarter of patients, the researchers looked at the cost-effectiveness of usual care plus minimal contact psychotherapy.
They randomly assigned primary care patients with subthreshold depression to receive minimal contact psychotherapy plus usual care from a general practitioner (n=107) or usual care alone (n=109).
The psychotherapy comprised a self-help manual with instructions on mood management. This was guided by six short telephone calls with a prevention worker.
After 1 year, 18% of patients receiving usual care alone had developed depressive disorders, compared with 12% of those receiving adjunctive psychotherapy.
Overall, the average annual per capita total cost for the usual care plus psychotherapy group was ?6766 (US$8161.07), which compared favorably with the ?8614 ($10,390.10) for the usual care group.
Economic evaluations that took into account the costs of all types of health services, as well as the costs that stem from production losses through absenteeism and reduced efficiency at work, showed a 70% probability that minimal contact psychotherapy in addition to usual care is more cost effective.
The investigators conclude that minimal contact psychotherapy can be used as a cost-effective adjunct to conventional primary care in order to reduce the incidence of depressive disorder.
"This choice is likely to result in health gains and economic benefits," they write in the British Journal of Psychiatry. "Therefore, its dissemination seems appropriate."
They add, however, that more research is needed into the cost-effectiveness of the therapy over the long term. The researchers also suggest that the therapy could be adapted for internet use in order to reduce provision costs, thereby promoting its use to a wider segment of the population.
Source: Br J Psychiatry 2006; 188: 330–336
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