PPubMed29 Jul 2019Cited 4×

Refractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial Shearer et al Cost-effectiveness of RO DBT for refractory depression

James Shearer, Thomas R. Lynch, Rampaul Chamba, Susan Clarke, Roelie J. Hempel, David G. Kingdon, Heather O'Mahen, Bob Remington, Sophie C. Rushbrook, Ian T. Russell, Maggie Stanton, Michaela Swales, Alan Watkins, Ben Whalley, Sarah Byford

Abstract

We initially present descriptive data on costs and outcomes adjusted for baseline differences in costs and relevant outcomes plus pre-specified clinical predictors as outlined in the accompanying clinical paper.9 We adjusted cost-effectiveness analyses for the same pre-specified clinical predictors and baseline values of the variables of interest (costs, EQ-5D-3L or HRSD). We analysed cost differences by t-tests with confidence intervals around adjusted mean differences estimated using non-parametric bootstrapping to reflect non-normality of cost data.25 We imputed missing cost, QALY and HRSD

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In its current resource‑intensive form, RO DBT is not a cost‑effective use of resources in the UK NHS.

What’s new

i.First economic evaluation of radically open dialectical behaviour therapy (RO DBT) for refractory depression
ii.Cost‑utility analysis conducted alongside a three‑centre randomised controlled trial (RefraMED)
iii.Detailed measurement of resource use and quality‑adjusted life‑years (QALYs) for RO DBT versus treatment‑as‑usual
iv.Sensitivity analyses exploring alternative perspectives, productivity costs, and longer follow‑up periods

How they did it

A cost‑utility analysis was performed alongside a three‑centre parallel‑group randomised trial comparing RO DBT plus treatment‑as‑usual (TAU) with TAU alone, adopting the UK NHS and personal social services perspective. Health outcomes were measured in QALYs using the EQ‑5D‑3L, and costs were analysed with t‑tests, non‑parametric bootstrapping, and multiple imputation for missing data.

What they found

Additional cost of RO DBT+TAU versus TAU: £7048
QALY gain for RO DBT+TAU versus TAU: 0.032
Incremental cost‑effectiveness ratio: £220,250 per QALY
Zero probability of being cost‑effective at the NICE £30,000 per QALY threshold

Caveats

✕High contact time and intensive delivery may not reflect routine NHS practice
✕Missing data required multiple imputation, introducing uncertainty
✕No power calculation for the cost‑effectiveness analysis
✕Results may not generalise to settings with different group attendance rates

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Refractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial Shearer et al Cost-effectiveness of RO DBT for refractory depression

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