Cost-Utility Analysis of Discontinuing Antidepressants in England Primary Care Patients Compared with Long-Term Maintenance: The ANTLER Study.
Journal
Applied health economics and health policy
ISSN: 1179-1896
Titre abrégé: Appl Health Econ Health Policy
Pays: New Zealand
ID NLM: 101150314
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
accepted:
19
10
2021
pubmed:
9
11
2021
medline:
11
3
2022
entrez:
8
11
2021
Statut:
ppublish
Résumé
Depression is a common mental health condition with considerable negative impact on health and well-being. Although antidepressants are recommended as first-line treatment, there is limited evidence regarding the cost effectiveness of long-term maintenance antidepressants for preventing relapse. Our objective was to calculate the mean incremental costs and quality-adjusted life-years (QALYs) over 12 months of discontinuing long-term antidepressant medication in well patients compared with maintenance, using patient-level trial data. We conducted a cost-utility analysis of 478 participants from 150 UK general practices recruited to a randomised, double-blind trial (ANTLER). QALYs were calculated from EQ-5D-5L and 12-Item Short Form survey (SF-12) results, with primary analysis using the EQ-5D-5L value set for England. Resource use was collected from primary care patient electronic medical records and self-completed questionnaires capturing mental-health-related resource use. Costs were calculated by applying standard UK unit costs to resource use. Adjustments were made for baseline variables. Participants randomised to discontinuation had significantly worse utility scores at 3 months (- 0.032; 95% confidence interval [CI] - 0.053 to - 0.011) but no significant difference in QALYs (- 0.011; 95% CI - 0.026 to 0.003) or costs (£3.11; 95% CI - 41.28 to 47.50) at 12 months. The probability that discontinuation was cost effective compared with maintenance was 12.9% at a threshold of £20,000 per QALY gained. Discontinuation of antidepressants was unlikely to be cost effective compared with maintenance for currently well patients on long-term antidepressants. However, this analysis provides no information on the wider impact of antidepressants. Our findings provide information on the potential impact of discontinuing long-term maintenance antidepressants and facilitate improving guidance for shared patient-clinician decision making. EudraCT number 2015-004210-26; ISRCTN number ISRCTN15969819.
Sections du résumé
BACKGROUND
Depression is a common mental health condition with considerable negative impact on health and well-being. Although antidepressants are recommended as first-line treatment, there is limited evidence regarding the cost effectiveness of long-term maintenance antidepressants for preventing relapse.
OBJECTIVES
Our objective was to calculate the mean incremental costs and quality-adjusted life-years (QALYs) over 12 months of discontinuing long-term antidepressant medication in well patients compared with maintenance, using patient-level trial data.
METHODS
We conducted a cost-utility analysis of 478 participants from 150 UK general practices recruited to a randomised, double-blind trial (ANTLER). QALYs were calculated from EQ-5D-5L and 12-Item Short Form survey (SF-12) results, with primary analysis using the EQ-5D-5L value set for England. Resource use was collected from primary care patient electronic medical records and self-completed questionnaires capturing mental-health-related resource use. Costs were calculated by applying standard UK unit costs to resource use. Adjustments were made for baseline variables.
RESULTS
Participants randomised to discontinuation had significantly worse utility scores at 3 months (- 0.032; 95% confidence interval [CI] - 0.053 to - 0.011) but no significant difference in QALYs (- 0.011; 95% CI - 0.026 to 0.003) or costs (£3.11; 95% CI - 41.28 to 47.50) at 12 months. The probability that discontinuation was cost effective compared with maintenance was 12.9% at a threshold of £20,000 per QALY gained.
CONCLUSIONS
Discontinuation of antidepressants was unlikely to be cost effective compared with maintenance for currently well patients on long-term antidepressants. However, this analysis provides no information on the wider impact of antidepressants. Our findings provide information on the potential impact of discontinuing long-term maintenance antidepressants and facilitate improving guidance for shared patient-clinician decision making.
TRIAL REGISTRATION
EudraCT number 2015-004210-26; ISRCTN number ISRCTN15969819.
Identifiants
pubmed: 34748164
doi: 10.1007/s40258-021-00693-x
pii: 10.1007/s40258-021-00693-x
pmc: PMC8847280
doi:
Substances chimiques
Antidepressive Agents
0
Banques de données
ISRCTN
['ISRCTN15969819']
EudraCT
['2015-004210-26']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
269-282Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. The Author(s).
Références
Viola S, Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. Br J Psychiatry Open. 2016;2(1):18–24.
doi: 10.1192/bjpo.bp.115.002246
McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S. Paying the Price: the cost of mental health care in England to 2026. London: King’s Fund; 2008.
McCrea RL, Sammon CJ, Nazareth I, Petersen I. Initiation and duration of selective serotonin reuptake inhibitor prescribing over time: UK cohort study. Br J Psychiatry. 2016;209(5):421–6.
doi: 10.1192/bjp.bp.115.166975
NICE. Depression in adults: recognition and management; clinical guideline CG90. 2009. [Online]. Available: https://www.nice.org.uk/guidance/cg90 .
Ramsberg J, Asseburg C, Henriksson M. Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model. PLoS ONE. 2012;7(8):e42003.
doi: 10.1371/journal.pone.0042003
Annemans L, Brignone M, Druais S, De Pauw A, Gauthier A, Demyttenaere K. Cost-effectiveness analysis of pharmaceutical treatment options in the first-line management of major depressive disorder in Belgium. Pharmacoeconomics. 2014;32:479–93.
doi: 10.1007/s40273-014-0138-x
Thom H, Jackson C, Welton N, Sharples L. Using parameter constraints to choose state structures in cost-effectiveness modelling. Pharmacoeconomics. 2017;35:951–62.
doi: 10.1007/s40273-017-0501-9
Marsden J, White M, Annand F, Burkinshaw P, Carville S, Eastwood B, Kelleher M, Knight J, O’Connor R, Tran A, Willey P, Greaves F, Taylor S. Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England. Lancet Psychiatry. 2019;6(11):935–50.
doi: 10.1016/S2215-0366(19)30331-1
Duffy L, Bacon F, Clarke CS, Donkor Y, Freemantle N, Gilbody S, Hunter RM, Kendrick T, Kessler D, King M, Lanham P, Lewis G, Mangin D, Marston L, Moore M, Nazareth I, Wiles N, Lewis G. A randomised controlled trial assessing the use of citalopram, sertraline, fluoxetine and mirtazapine in preventing relapse in primary care patients who are taking long-term maintenance antidepressants (ANTLER: ANTidepressants to prevent reLapse in dEpRes. Trials. 2019;20:319.
doi: 10.1186/s13063-019-3390-8
Lewis G, Marston L, Duffy L, Freemantle N, Gilbody S, Hunter R, Kendrick T, Kessler D, Mangin D, King M, Lanham P, Moore M, Nazareth I, Wiles N, Bacon F, Bird M, Brabyn S, Burns A, Clarke CS, Hunt A, Pervin J, Lewis G. Maintenance or discontinuation of antidepressants in primary care. N Engl J Med. 2021;385(14):1257–67.
doi: 10.1056/NEJMoa2106356
Taves DR. Minimization: a new method of assigning subjects to treatment and control groups. Clin Pharmacol Ther. 1974;15:443–53.
doi: 10.1002/cpt1974155443
Joint Formulary Committee. British National Formulary (online). [Online]. Available: http://www.medicinescomplete.com . Accessed Feb 2020.
Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. London: Gaskell; 2001. p. 200–24.
Curtis L, Burns A. Unit costs of health and social care 2019. Canterbury: Personal Social Services Research Unit, University of Kent; 2019.
NHS Improvement. NHS reference costs. [Online]. Available: https://improvement.nhs.uk/resources/national-cost-collection/ .
Office for National Statistics. ONS occupation codes (PROV—Occupation SOC10 (4) Table 14.1a Weekly pay—Gross 2019.xls). 29 October 2019. [Online]. Available: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/datasets/occupation4digitsoc2010ashetable14 . Accessed June 2020.
Dolan P. Modelling valuations for EuroQol health states. Med Care. 1997;35:1095–108.
doi: 10.1097/00005650-199711000-00002
Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.
doi: 10.1097/00005650-199603000-00003
Brazier JE, Roberts J. The estimation of a preference-based measure of health from the SF-12. Med Care. 2004;42(9):851–9.
doi: 10.1097/01.mlr.0000135827.18610.0d
Devlin NJ, Krabbe PF. The development of new research methods for the valuation of EQ-5D-5L. Eur J Health Econ. 2013;14(Suppl. 1):S1–3.
doi: 10.1007/s10198-013-0502-3
Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2018;27:7–22.
doi: 10.1002/hec.3564
van Hout B, Janssen MF, Feng Y-S, Kohlmann T, Busschbach J, Golicki D, Lloyd A, Scalone L, Kind P, Pickard AS. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health. 2012;15(5):708–15.
doi: 10.1016/j.jval.2012.02.008
NICE. Guide to the methods of technology appraisal. 2013. [Online]. Available: https://www.nice.org.uk/process/pmg9 .
Franklin M, Enrique A, Palacios J, Richard D. Psychometric assessment of EQ-5D-5L and ReQoL measures in patients with anxiety and depression: construct validity and responsiveness. Qual Life Res. 2021;30:2633–47.
doi: 10.1007/s11136-021-02833-1
Marston L, Freemantle N, Hunter RM, Clarke CS, Duffy L, Lewis G. ANTLER statistical analysis plan, version 3, 16 January 2020. UCL Discovery database.
Isaacs A, Critchley J, See Tai S, Buckingham K, Westley D, Harridge SD, Smith C, Gottlieb JM. Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only. Health Technol Assess. 2007;11(10). https://doi.org/10.3310/hta11100 .
Pope I, Burn H, Ismail SA, Harris T, McCoy D. A qualitative study exploring the factors influencing admission to hospital from the emergency department. BMJ Open. 2017;7:e011543.
doi: 10.1136/bmjopen-2016-011543
Rosie Lovett and Sophie Cooper, NICE Science policy and research programme. NICE to support new valuation study for England for EQ-5D-5L questionnaire; study will measure public’s preference for different health states. 2019. [Online]. Available: https://www.nice.org.uk/news/blog/nice-to-support-new-valuation-study-for-england-for-eq-5d-5l-questionnaire .
Hunter RM, Baio G, Butt T, Morris S, Round J, Freemantle N. An educational review of the statistical issues in analysing utility data for cost-utility analysis. Pharmacoeconomics. 2015;33(4):355–66.
doi: 10.1007/s40273-014-0247-6
Kearns B. NICE DSU report: the relevance of future, unrelated health costs in economic evaluation in NICE appraisals. Decision Support Unit, School of Health and Related Research (ScHARR), University of Sheffield; 2020.
Zellner A. An efficient method of estimating seemingly unrelated regression equations and tests for aggregation bias. J Am Stat Assoc. 1962;57(298):348–68.
doi: 10.1080/01621459.1962.10480664
Leurent B, Gomes M, Faria R, Morris S, Grieve R, Carpenter JR. Sensitivity analysis for not-at-random missing data in trial-based cost-effectiveness analysis: a tutorial. Pharmacoeconomics. 2018;36:889–901.
doi: 10.1007/s40273-018-0650-5
Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.
doi: 10.1002/9780470316696
Fenwick E, Claxton K, Sculpher M. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ. 2001;10:779–87.
doi: 10.1002/hec.635
Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997;6:327–40.
doi: 10.1002/(SICI)1099-1050(199707)6:4<327::AID-HEC282>3.0.CO;2-W
StataCorp. Stata Statistical Software: release 14. College Station: StataCorp LP; 2015.
Royston P, White I. Multiple imputation by chained equations (MICE): implementation in stata. J Stat Softw. 2011;45(4).
McCrone P, Patel A, Knapp M, Schene A, Koeter M, Amaddeo F. A comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia. J Ment Health Policy Econ. 2009;12(1):27–31.
pubmed: 19346564
Morey E, Thacher J, Craighead WE. Patient preferences for depression treatment programs and willingness to pay for treatment. J Ment Health Policy Econ. 2007;10(2):73–85.
pubmed: 17603148
Cartwright C, Gibson K, Read J, Cowan O, Dehar T. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Prefer Adher. 2016;10:1401–7.
doi: 10.2147/PPA.S110632
Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Brejcha C, Cardy J, Causley A, Cowderoy S, Evans A, Gradinger F, Kaur S, Lanham P, Morant N, Richards J, Shah P, Sutton H, Vicary R, Weaver A, Wilks J, Williams M, Taylor RS, Byford S. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386:63–73.
doi: 10.1016/S0140-6736(14)62222-4