CBT vs antidepressants: Which is more cost-effective?

No consistent superior cost-effectiveness has been observed in either second-generation antidepressants (SGAs) or cognitive behavioural therapy (CBT) when compared to the other, according to a study.

Model projections showed higher quality-adjusted life-years (QALYs) with CBT (3 days more at 1 year and 20 days more at 5 years) than with SGA, with higher costs at 1 year (healthcare sector, $900; societal, $1,500) but lower costs at 5 years (healthcare sector, –$1,800; societal –$2,500).

On the other hand, probabilistic sensitivity analyses revealed a 64–77-percent likelihood of having an incremental cost-effectiveness ratio of ≤$100,000 per QALY at 1 year with SGA and a 73–77-percent likelihood at 5 years with CBT.

Overall uncertainty in the optimal treatment was mainly driven by the uncertainty in the relative risk for relapse of depression.

“Given many patients' preference for psychotherapy over pharmacotherapy, increasing patient access to CBT may be warranted,” the investigators said.

This study used a decision analytic model to quantify the cost-effectiveness of CBT vs SGA for the initial treatment of depression. Relative effectiveness data were obtained from a meta-analysis of randomized controlled trials, while additional clinical and economic data were sourced from other publications.

Adults with newly diagnosed major depressive disorder in the United States were treated with either an SGA or group and individual CBT. Outcome measures were costs in 2014 US dollars, QALYs and incremental cost-effectiveness ratios.

The study was limited by the lack of long-term trials comparing CBT and SGA.

“Most guidelines for major depressive disorder recommend initial treatment with either SGA or CBT,” the investigators said. “Although most trials suggest that these treatments have similar efficacy, their health economic implications are uncertain.”