Posted 03.25.2020 | by AMRA
Major Depressive Disorder (MDD) is a severe recurrent mood disorder that affects 4-5% of the North American population at any given point in time. The average patient with MDD suffers 5-9 episodes over the course of a lifetime, and the personal, familial, and social costs of severe depression make relapse prevention a priority. Previous research shows Mindfulness-Based Cognitive Therapy (MBCT) to be roughly as effective as antidepressant medication maintenance in preventing MDD relapse.
While antidepressant medication maintenance is effective, many patients have difficulty tolerating medication side-effects including insomnia, dizziness, drowsiness, dry mouth, nausea, loss of libido and might prefer a non-drug intervention.
Pahlevan et al. [Canadian Journal of Psychology] used already extant data sets to calculate the efficacy, utility, and cost effectiveness of MBCT vs. antidepressant medication maintenance for preventing relapse over 24-months in patients with recurrent MDD treated within the Canadian healthcare system.
The data were drawn from previously published studies comparing the efficacy of MBCT and antidepressant medication. MBCT is an 8-week group-based intervention combining elements of MBSR and cognitive therapy to prevent MDD relapse. Antidepressant medication maintenance uses antidepressant medication to prevent relapse.
Estimated parameters for adherence, relapse, and quality-adjusted life years (QALYs) were drawn from 11 Canadian randomized controlled trials. MBCT patients who attended at least 4 MBCT classes, and antidepressant medication patients who took their medication (venlafaxine, 375 mgs. daily) regularly, according to prescription refill and self-report data, were considered treatment compliant. Outcomes for treatment compliant and non-compliant patients were assessed at 12 and 24 months (only one of the 11 studies followed patients for 24 months).
Data on the estimated costs of MBCT, antidepressant medication, and relapse treatment were drawn from a multisite mindfulness center in Ontario, the Ontario Healthcare Insurance Plan, and the Ontario Drug Benefit database. Costs estimates were based on the assumption that patients who relapsed remained relapsed for the succeeding 12 months.
Estimates of outpatient, ER, and hospitalization costs were drawn from a prior study that followed 409 patients with MDD for five years. Productivity loss estimates were derived from a prior study of 1,000 adults with self-reported depression who completed work performance questionnaires.
The results showed that the two-year costs associated with MBCT were $15,030 (in Canadian dollars) per patient, while the costs associated with antidepressant medication treatment were $17,255 per patient. MBCT incrementally increased patient well-being by 1.18 QALYs, while antidepressant medication increased patient well-being by 1.10 QALYs.
Both treatments were deemed cost effective, but MBCT delivered a marginally superior improved quality-of-life as well as a cost savings margin of $2,225 per patient.
This study suggests that MBCT is superior to antidepressant medication in terms of cost savings and incremental improvement in quality of life. The study did not evaluate the cost effectiveness of these treatments compared to a combined MBCT-antidepressant medication regimen. It is not known whether MBCT delivered under customary clinical circumstances would prove as cost effective as MBCT delivered during the course of research trials.
Pahlevan, T., Ung, C., & Segal, Z. (2020). Cost–Utility analysis of mindfulness-based cognitive therapy versus antidepressant pharmacotherapy for prevention of depressive relapse in a canadian context. The Canadian Journal of Psychiatry.