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Refractory depression – Cost-Effectiveness of Radically Open Dialectical Behaviour Therapy (RefraMED): findings of trial-based economic evaluation

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James Douglas Shearer, Tom Lynch, R Chamba, Clarke Sue, Roelie Hempel, David Kingdon, Heather O'Mahen, B. Remington, S Rushbrook, I. T. Russell, M Stanton, M. Swales, A. Watkins, B. Whalley, Sarah Byford

Original languageEnglish
Number of pages25
JournalBJPsych Open
Publication statusAccepted/In press - 7 Jul 2019


King's Authors


Refractory depression is a major contributor to the economic burden of depression. Radically Open Dialectical Behaviour Therapy (RO DBT) is an unevaluated new treatment targeting over-controlled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money.
To estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in patients with refractory depression.
We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in quality-adjusted life years, estimated using the EQ-5D-3L measure of health-related quality of life.
The additional cost of RO DBT plus TAU compared to TAU alone was £7,048, which was associated with a difference of 0.032 QALYs, yielding an ICER of £220,250 per QALY. This ICER was well above the NICE upper threshold of £30,000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared to TAU at the NICE £30,000 threshold.
In its current resource-intensive form, RO DBT was not a cost-effective use of resources in the UK NHS.

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