Related Experiment Video
Updated: Jun 7, 2026
05:19
Closed-Loop Neurostimulation for Biomarker-Driven, Personalized Treatment of Major Depressive Disorder
Published on: July 7, 2023
Evaluating Treatment Sequences in Major Depressive Disorder Using an Open-Source Health Economic Model Based on
Alice Kate Cummings-Joyner1, Richard H Chapman2, Yuan-Yuan Michelle Cheng2
1Medicus Economics LLC, Milton, MA, USA.
Summary
This study developed a simulation model to evaluate major depressive disorder (MDD) treatment sequences. Certain sequences, like SSRI followed by SNRI and other combinations, showed better value than no treatment or SSRI monotherapy over five years.
Area of Science:
- Health Economics
- Pharmacoeconomics
- Clinical Research
Background:
- Major depressive disorder (MDD) poses a significant public health challenge, necessitating effective treatment strategies.
- Optimizing treatment sequences is crucial for improving patient outcomes and managing healthcare costs in MDD.
Purpose of the Study:
- To develop and utilize a patient-level discrete event simulation model to assess the economic value of various treatment sequences for newly diagnosed adult patients with MDD.
- To compare the cost-effectiveness of different treatment pathways, including monotherapy, combination therapy, and no treatment, over a five-year period.
Main Methods:
- A discrete event simulation model was developed, incorporating patient heterogeneity and real-world treatment pathways.
- Model specifications were informed by stakeholder engagement, literature review, and claims data analysis.
- Key outcomes included time-to-response, remission rates, net monetary benefit (NMB), and incremental cost-effectiveness ratios (ICERs).
Main Results:
- All modeled treatment sequences, including those with Selective Serotonin Reuptake Inhibitors (SSRIs), were superior to no treatment in terms of quality-adjusted life years (QALYs) and NMB.
- A specific sequence (SSRI, SNRI, SNRI + atypical antidepressant, SNRI + antipsychotic) demonstrated higher QALYs and NMB than four lines of SSRI, with an ICER of approximately $28,000/QALY.
- SSRI followed by SSRI plus intensive psychotherapy was not cost-effective due to high costs and modest QALY gains.
Conclusions:
- Treatment sequences involving combinations of pharmacotherapy and psychotherapy can offer significant value in managing MDD.
- The developed simulation model provides valuable insights into the relative effectiveness and cost-effectiveness of different MDD treatment strategies.
- Informed decision-making regarding treatment pathways is essential for optimizing patient care and outcomes in major depressive disorder.
More Related Videos
Related Concept Videos
01:23Antidepressant Drugs: MAOIs and Other Agents
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
01:27Depressive Disorders: MDD and Dysthymia
Depressive disorders are a group of mental health conditions characterized by pervasive feelings of sadness, diminished pleasure in life, and a significant impact on daily functioning. These conditions are most prevalent in individuals during their 30s and affect women at twice the rate of men. Contrary to popular belief, younger individuals are generally more susceptible to these disorders than older adults. Two key types of depressive disorders include Major Depressive Disorder (MDD) and...
01:27Depressive Disorders: Etiology
Depressive disorders result from a complex interplay of biological, psychological, and sociocultural factors, each contributing uniquely to the development and persistence of the condition. Understanding these factors provides critical insight into the multifaceted nature of depression.
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...
01:15Methods of Documentation VI: Case Management Model
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
For example, a patient with a chronic illness...
01:15Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions
PK–PD modeling has significantly influenced FDA regulatory decisions, particularly drug approval, dosage optimization, and labeling. These models integrate pharmacokinetics (PK) and pharmacodynamics (PD) to predict drug behavior and effects, aiding in optimizing dosing regimens and enhancing the probability of clinical trial success.One notable example is Nesiritide (Natrecor®), a recombinant human brain natriuretic peptide for treating acute decompensated congestive heart failure (CHF).