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Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial.

Publication ,  Journal Article
Domino, ME; Foster, EM; Vitiello, B; Kratochvil, CJ; Burns, BJ; Silva, SG; Reinecke, MA; March, JS
Published in: J Am Acad Child Adolesc Psychiatry
July 2009

OBJECTIVE: The cost-effectiveness of three active interventions for major depression in adolescents was compared after 36 weeks of treatment in the Treatment of Adolescents with Depression Study. METHOD: Outpatients aged 12 to 18 years with a primary diagnosis of major depression participated in a randomized controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Three hundred twenty-seven participants randomized to 1 of 3 active treatment arms, fluoxetine alone (n = 109), cognitive-behavioral therapy (n = 111) alone, or their combination (n = 107), were evaluated for a 3-month acute treatment and a 6-month continuation/maintenance treatment period. Costs of services received for the 36 weeks were estimated and examined in relation to the number of depression-free days and quality-adjusted life-years. Cost-effectiveness acceptability curves were also generated. Sensitivity analyses were conducted to assess treatment differences on the quality-adjusted life-years and cost-effectiveness measures. RESULTS: Cognitive-behavioral therapy was the most costly treatment component (mean $1,787 [in monotherapy] and $1,833 [in combination therapy], median $1,923 [for both]). Reflecting higher direct and indirect costs associated with psychiatric hospital use, the costs of services received outside Treatment of Adolescents with Depression Study in fluoxetine-treated patients (mean $5,382, median $2,341) were significantly higher than those in participants treated with cognitive-behavioral therapy (mean $3,102, median $1,373) or combination (mean $2,705, median $927). Accordingly, cost-effectiveness acceptability curves indicate that combination treatment is highly likely (>90%) to be more cost-effective than fluoxetine alone at 36 weeks. Cognitive-behavioral therapy is not likely to be more cost-effective than fluoxetine. CONCLUSIONS: These findings support the use of combination treatment in adolescents with depression over monotherapy.

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Published In

J Am Acad Child Adolesc Psychiatry

DOI

EISSN

1527-5418

Publication Date

July 2009

Volume

48

Issue

7

Start / End Page

711 / 720

Location

United States

Related Subject Headings

  • Psychometrics
  • Personality Assessment
  • Male
  • Humans
  • Hospitalization
  • Follow-Up Studies
  • Fluoxetine
  • Female
  • Drug Costs
  • Double-Blind Method
 

Citation

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Domino, M. E., Foster, E. M., Vitiello, B., Kratochvil, C. J., Burns, B. J., Silva, S. G., … March, J. S. (2009). Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. J Am Acad Child Adolesc Psychiatry, 48(7), 711–720. https://doi.org/10.1097/CHI.0b013e3181a2b319
Domino, Marisa Elena, E Michael Foster, Benedetto Vitiello, Christopher J. Kratochvil, Barbara J. Burns, Susan G. Silva, Mark A. Reinecke, and John S. March. “Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial.J Am Acad Child Adolesc Psychiatry 48, no. 7 (July 2009): 711–20. https://doi.org/10.1097/CHI.0b013e3181a2b319.
Domino ME, Foster EM, Vitiello B, Kratochvil CJ, Burns BJ, Silva SG, et al. Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. J Am Acad Child Adolesc Psychiatry. 2009 Jul;48(7):711–20.
Domino, Marisa Elena, et al. “Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial.J Am Acad Child Adolesc Psychiatry, vol. 48, no. 7, July 2009, pp. 711–20. Pubmed, doi:10.1097/CHI.0b013e3181a2b319.
Domino ME, Foster EM, Vitiello B, Kratochvil CJ, Burns BJ, Silva SG, Reinecke MA, March JS. Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. J Am Acad Child Adolesc Psychiatry. 2009 Jul;48(7):711–720.
Journal cover image

Published In

J Am Acad Child Adolesc Psychiatry

DOI

EISSN

1527-5418

Publication Date

July 2009

Volume

48

Issue

7

Start / End Page

711 / 720

Location

United States

Related Subject Headings

  • Psychometrics
  • Personality Assessment
  • Male
  • Humans
  • Hospitalization
  • Follow-Up Studies
  • Fluoxetine
  • Female
  • Drug Costs
  • Double-Blind Method