Value of monitoring negative emotional bias in primary care in England for personalised antidepressant treatment: a modelling study.
Evid Based Ment Health
; 22(4): 145-152, 2019 Nov.
Article
em En
| MEDLINE
| ID: mdl-31562131
ABSTRACT
BACKGROUND:
Depressed patients often focus on negative life events. Effective antidepressant therapy reverses this negative emotional bias (NEB) within 1 week. Clinical therapeutic effect usually requires 4-6 weeks. The value of implementing NEB monitoring for the personalisation of antidepressant therapy is unknown.OBJECTIVE:
To estimate the likely outcome and cost consequences of adopting the P1vital Oxford Emotional Test Battery (ETB) for this purpose in routine primary care in England.METHODS:
A hybrid decision analytic model (decision tree plus Markov model) was developed to estimate the cost-effectiveness of ETB monitoring versus no ETB over 52 weeks using quality-adjusted life years (QALYs). Differences in depression severity, episode type and analytical perspectives were considered. Input data were derived from relevant guidelines, literature, national databases, expert opinion and the developers for the year 2013. Multiple sensitivity analyses addressed uncertainty.FINDINGS:
The mean number of ETB tests is 2.162 per newly diagnosed patient and 2.166 per patient with recurrent depression. The incremental cost-effectiveness of ETB versus 'no ETB' is £4355/QALY from the healthcare perspective. From the broader societal perspective, ETB is more effective and cost saving.CONCLUSIONS:
Monitoring negative emotional bias in primary care in England for personalised antidepressant treatment using ETB seems as an effective and cost-effective option under all considered scenarios (including worst case). Its main economic value seems to lie in reduced productivity loss as opposed to healthcare savings. CLINICAL IMPLICATIONS The test supports accelerated application of evidence-based depression care. Further optimisation and implementation in the ongoing European PReDicT trial is ongoing.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Avaliação de Resultados em Cuidados de Saúde
/
Análise Custo-Benefício
/
Anos de Vida Ajustados por Qualidade de Vida
/
Transtorno Depressivo
/
Monitorização Fisiológica
/
Antidepressivos
Tipo de estudo:
Guideline
/
Prognostic_studies
Aspecto:
Patient_preference
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
Evid Based Ment Health
Ano de publicação:
2019
Tipo de documento:
Article