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Related Experiment Video

Updated: Jul 11, 2025

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
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Comparative analysis of algorithm-guided treatment and predefined duration treatment programmes for depression:

Fang Li1, Ellen Visser2, Maarten Brilman2

  • 1University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands f.li@rug.nl.

BMJ Mental Health
|November 15, 2023
PubMed
Summary

An algorithm-guided depression treatment yielded greater health gains but was more expensive, proving not cost-effective at current thresholds. This research aids decision-makers in optimizing treatment allocation and improving care quality.

Keywords:
depression & mood disorders

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Area of Science:

  • Health Economics
  • Mental Health Services Research
  • Clinical Decision Making

Background:

  • Cost-effectiveness data is crucial for efficient depression treatment allocation and improved care quality.
  • Understanding the economic impact of different depression management strategies is essential.

Purpose of the Study:

  • To compare the real-world cost-effectiveness of two depression treatment programs: algorithm-guided remission-focused vs. patient preference-centered response-focused.
  • To evaluate these programs using routine care data from a healthcare system perspective.

Main Methods:

  • A naturalistic study involving 6295 participants was conducted over a 2-year period.
  • Quality-Adjusted Life Years (QALY) and Depression-Free Days (DFD) were used as outcome measures.
  • Incremental Cost-Effectiveness Ratios (ICERs) were calculated, with uncertainty assessed via bootstrapping and sensitivity analysis.

Main Results:

  • The algorithm-guided program resulted in more DFDs (12) and QALYs (0.013) but incurred higher costs (€3070).
  • ICERs were approximately €256/DFD and €236,154/QALY, indicating lower cost-effectiveness compared to the predefined duration program.
  • The algorithm-guided program had <10% probability of being cost-effective at a €50,000/QALY threshold; sensitivity analyses confirmed these findings.

Conclusions:

  • While the algorithm-guided program achieved greater health gains, its higher cost rendered it not cost-effective within current Dutch economic thresholds.
  • Both treatment programs offer distinct benefits, contingent upon available patient preferences and healthcare budgets.
  • The study offers valuable insights for optimizing treatment allocation and enhancing the cost-effectiveness of depression care.