Research reportEconomic evaluation of audio based resilience training for depression in primary care
Introduction
The prevalence, burden and financial impact of depression are well documented (Sobocki et al., 2006, Wittchen and Jacobi, 2005). However, its management in primary care, the principal locus of treatment in the UK, has been described as suboptimal (Barley et al., 2011). Non-economic barriers to superior depression care exist (Barley et al., 2011). Moreover, the lack of resources for delivering effective psychological treatment options such as cognitive behavioural therapy (CBT) is a key problem. This has increased the interest in low-cost, low intensity psychosocial interventions including computerised versions of cognitive behavioural therapy (CCBT). The existence of (albeit limited) evidence supporting its clinical and cost-effectiveness (Foroushani et al., 2011, Gerhards et al., 2010, Kaltenthaler et al., 2006) has led to recommendations of CCBT as a treatment option for mild to moderate depression by the National Institute for Health and Clinical Excellence (NICE, 2010).
Alternative therapies remain relatively underexplored from a health economic perspective (Solomon et al., 2013, Spinks and Hollingsworth, 2009). Although these may be purchased out of pocket, from a public healthcare perspective failure of rigorous evaluation may mean that cost-effective treatment options are not utilised. This paper aims to assess the cost-effectiveness of an alternative psychosocial therapy for depression in primary care, i.e. an audio based resilience training, in comparison with treatment as usual (TAU) and one of the most commonly used CCBT programmes in the UK.
Section snippets
Interventions
A self-help audio-based psychosocial therapy, Positive Mental Training (PosMT) as detailed by Dobbin et al. (2009) was assessed. At first contact, participants were shown a 10 min introductory video, followed by an 18 min audio recording. This was the first of a modular 12 week CD based series during which individuals were advised to listen to one 18 minute track at home every day for a week (12 tracks in total). Tracks covered relaxation, positive suggestion, visualisation and mindfulness
Results
The model inputs are detailed in Table 1, Table 2, Table 3. Table 1 provides a breakdown of the outcomes, i.e. cost and benefits by health state. The point estimates for follow-up service costs persons suffering from mild depression were lower than those for minimal depression and a six fold increase in costs was observed between the moderate and severe group. Given the assumptions made, in the base case the cost of the PosMT intervention was determined to be approximately a third of that for
Discussion and limitations
For individuals affected by moderate and (in particular) severe depression the results of this evaluation suggest that PosMT may represent good value for money from a healthcare perspective. However, gaps remain in the evidence base surrounding the efficacy of this intervention for treating mild and minimal depression. Biases may be present because the treatment efficacy for PosMT was based on a randomised preference trial (Gemmell and Dunn, 2011, House of Lords' Science and Technology
Role of funding source
This study was funded by the Foundation for Positive Mental Health, a charity registered in Scotland No SC041132 which distributes Positive Mental Training. It provided access to data on interventions evaluated. AD and SR work for the Foundation and contributed to the paper.
Conflict of interest
Alistair Dobbin and Sheila Ross are involved in the development and commercial exploitation of Positive Mental Training, the audio based resilience training used in this study. Paul McCrone has conducted an economic evaluation of Beating the Blues, a study partially funded by the Ultrasis, the distributors of the software.
Acknowledgements
None.
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