Comparing Cost-Effectiveness of Aripiprazole Augmentation With Other "Next-Step" Depression Treatment Strategies: A Randomized Clinical Trial.

Autor:	Yoon J; 795 Willow Rd, 152 MPD, Menlo Park, CA 94025. jean.yoon@va.gov.; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.; Department of General Internal Medicine, UCSF School of Medicine, San Francisco, California, USA., Zisook S; VA San Diego Healthcare System, San Diego, California, USA.; UCSD School of Medicine, San Diego, California, USA., Park A; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA., Johnson GR; Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA., Scrymgeour A; Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, VA Medical Center, Albuquerque, New Mexico, USA., Mohamed S; Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.; Yale University School of Medicine, New Haven, Connecticut, USA.
Jazyk:	angličtina
Zdroj:	The Journal of clinical psychiatry [J Clin Psychiatry] 2018 Dec 18; Vol. 80 (1). Date of Electronic Publication: 2018 Dec 18.
DOI:	10.4088/JCP.18m12294
Abstrakt:	Objective: To compare the cost-effectiveness of 3 common alternate treatments for depression. Methods: The cost-effectiveness analysis was conducted as part of a randomized clinical trial, the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D) trial, in which patients were randomized from December 2012 to May 2015 and followed for 12 weeks in 35 Veterans Affairs medical centers. Depression diagnosis was based on ICD-9 codes. Patients were randomized to standard antidepressant therapy augmented with aripiprazole, standard antidepressant therapy augmented with bupropion, or switch to bupropion. Remission was measured using the 16-item Quick Inventory of Depressive Symptomatology-Clinican Rated. Outcomes included the incremental cost-effectiveness ratio (ICER) comparing costs per remission and costs per quality-adjusted life-year (QALY) with 12 weeks as the time horizon using the health care sector perspective. Results: The mean age of participants enrolled in the trial (N = 1,522) was 54 years, and participants were predominantly male. The rate of remission at 12 weeks was highest for the aripiprazole augmentation arm (29%), followed by bupropion augmentation (27%), and lowest for switching to bupropion (22%). Switching to bupropion was strongly dominated by bupropion augmentation at an ICER of -$640/remission (95% CI, -$5,770 to $3,008). The ICER for the aripiprazole augmentation versus switching to bupropion was $1,074/remission (95% CI, $47 to $5,022), and the ICER for aripiprazole augmentation versus bupropion augmentation was $5,094/remission (95% CI, -$34,027 to $32,774). There were no significant differences in QALYs, mental health care costs, employment, or other work and social adjustment outcomes between treatment groups. Conclusions: In treatment of depression with less than optimal response, augmentation with either aripiprazole or bupropion was cost-effective relative to switching to bupropion. Trial Registration: ClinicalTrials.gov identifier: NCT01421342. (© Copyright 2018 Physicians Postgraduate Press, Inc.)
Databáze:	MEDLINE
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