Should the Spanish National Health System Invest in Psychotherapy for Depression? A Microsimulation Cost-Utility...

Cognitive behavioral therapy (CBT) represents an effective psychotherapeutic intervention for patients with depression compared with anti-depressant medications (ADM).

The aim of this study was to determine the economically justifiable price (EJP), consisting of an average cost of CBT per patient-year for which the intervention is cost effective versus ADM for the treatment of adults with depression in Spain.

A patient-level microsimulation model was developed to conduct a cost-utility analysis over the patients' lifetime horizon. Patient demographics, epidemiology of depression, health resources consumption and health utilities feeding the model were sourced from the Spanish national health survey. Additional longitudinal inputs were derived from previously published economic analyses in depression. In the base case, the EJP was estimated for several willingness-to-pay (WTP) thresholds, including €0/QALY (dominancy) and €22,000/QALY. Two scenarios were considered presenting CBT as a substitute of ADM and both CBT and ADM combined (CBT/ADM). The robustness of the model and its results were tested using both deterministic and probabilistic sensitivity analyses.

For the scenario of CBT versus ADM, the EJP was estimated at €5236 for a WTP threshold of €22,000/QALY. At an EJP of €549, CBT was a dominant intervention compared with ADM. In the scenario considering CBT/ADM versus ADM, the EJP was €5449, CBT/ADM being dominant at an EJP of €255. Sensitivity analyses demonstrated that the base-case results were robust.

CBT and CBT/ADM achieved incremental health benefits compared with ADM. Under the estimated EJPs, CBT and CBT/ADM could represent a cost effective or dominant intervention for adult patients with depression in Spain.