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Modelling the cost-effectiveness of pharmacotherapy compared with cognitive–behavioural therapy and combination therapy for the treatment of moderate to severe depression in the UK

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)3019-3031
Number of pages13
JournalPsychological Medicine
Issue number14
Early online date4 Jun 2015
Publication statusPublished - Oct 2015


  • Manuscript 150413

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    Accepted author manuscript

  • Appendix 141010

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  • Figures 141010

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  • Tables 141010

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King's Authors


Background The National Institute of Health and Care Excellence (NICE) in England and Wales recommends the combination of pharmacotherapy and psychotherapy for the treatment of moderate to severe depression. However, the cost-effectiveness analysis on which these recommendations are based has not included psychotherapy as monotherapy as a potential option. For this reason, we aimed to update, augment and refine the existing economic evaluation.

Method We constructed a decision analytic model with a 27-month time horizon. We compared pharmacotherapy with cognitive–behavioural therapy (CBT) and combination treatment for moderate to severe depression in secondary care from a healthcare service perspective. We reviewed the literature to identify relevant evidence and, where possible, synthesized evidence from clinical trials in a meta-analysis to inform model parameters.

Results The model suggested that CBT as monotherapy was most likely to be the most cost-effective treatment option above a threshold of £22 000 per quality-adjusted life year (QALY). It dominated combination treatment and had an incremental cost-effectiveness ratio of £20 039 per QALY compared with pharmacotherapy. There was significant decision uncertainty in the probabilistic and deterministic sensitivity analyses.

Conclusions Contrary to previous NICE guidance, the results indicated that even for those patients for whom pharmacotherapy is acceptable, CBT as monotherapy may be a cost-effective treatment option. However, this conclusion was based on a limited evidence base, particularly for combination treatment. In addition, this evidence cannot easily be transferred to a primary care setting.

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