Research report
Economic evaluation of audio based resilience training for depression in primary care

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Abstract

Background

Although there is some evidence on the effectiveness and cost-effectiveness of computerised cognitive behavioural therapy (CCBT) for treating anxiety and depression in primary care, alternative low-cost psychosocial interventions have not been investigated.

Methods

The cost-effectiveness of an audio based resilience training (Positive Mental Training, PosMT) was examined using a decision model. Patient level cost and effectiveness data from a trial comparing a CCBT treatment and usual care and effectiveness data from a study on PosMT were used to inform this.

Results

Net benefits of CCBT and PosMT were approximately equal in individuals with ‘moderate’ depression at baseline and markedly in favour of PosMT for the ‘severe’ depression subgroup. With only four observations in the ‘mild’ depression category for PosMT, the existing evidence base remains unaltered.

Limitations

Efficacy data for the PosMT arm was derived from a study using a partially randomised preference design and the model structure contains simplifications due to lack of data availability.

Conclusion

PosMT may represent good value for money in treatment of depression for certain groups of patients. More research in this area may be warranted.

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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