The cost-effectiveness of predictive algorithm guided primary antidepressant treatment: economic evaluation of the multinational PReDicT randomised controlled trial.
Perić N., Mayer S., Helter T., Deckert J., Gorwood P., Perez V., Reif A., Ruhe HG., Veltman DJ., van Schaik A., Morriss RK., Beckenstrom A., Dawson GR., Dourish CT., Dias R., Kingslake J., Browning M., Simon J.
BACKGROUND: The PReDicT study showed that predictive algorithm-guided antidepressant treatment reduces anxiety and improves functioning in patients with depression. AIMS: To estimate the costs, outcomes and cost-effectiveness of the PReDicT test compared with treatment as usual (TAU) for primary depression care in five European countries. METHOD: Within-trial economic analysis was conducted over 24 weeks from the health/social care and societal perspectives alongside the PReDicT trial (NCT02790970) in France, Germany, The Netherlands, Spain, and the UK, according to Consolidated Health Economic Evaluation Reporting Standards guidelines. We calculated quality-adjusted life-years (QALYs) based on the EQ-5D-5L, capability-weighted life-years based on the Oxford Capabilities Questionnaire - Mental Health (OxCAP-MH) (Germany and UK only), and costs for 2018 (€). Multiple imputation for missing data, multivariable regression for cost and outcome differences, and bootstrapping and sensitivity analyses for uncertainty were conducted. RESULTS: There were significant outcome improvements (EQ-5D-5L PRedicT: +0.139; TAU: +0.140) and societal cost reductions (PRedicT: -€2589; TAU: -€2602) in both groups (N = 913) between the before and during trial periods. In the UK and Germany (n = 619), the PReDicT group showed significant additional capability well-being gains (OxCAP-MH: +2.127, p = 0.021). Cost-effectiveness probabilities ranged from 46 to 59% at trial level, but exceeded 80% in the UK. Results remained stable across different sensitivity analyses, with societal cost-effectiveness improved for those (self-)employed. CONCLUSIONS: We observed potentially meaningful health and economic benefits of closely monitored antidepressant treatment, as implemented in both treatment and control arms of the PReDicT trial. The PReDicT test itself had some added benefits in improved capabilities and productivity, however, with great uncertainty and country-level variations in cost-effectiveness.