Depression interventions for individuals with coronary artery disease – Cost-effectiveness calculations from an Irish perspective

Samira Barbara Jabakhanji, Jan Sorensen, Robert M. Carney, Chris Dickens, Martin Dempster, Jonathan Gallagher, Isabela Caramlau, Frank Doyle

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease. Methods: We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise. Results: After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness. Discussion: Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.

Original languageEnglish
Article number110747
JournalJournal of Psychosomatic Research
Volume155
DOIs
StatePublished - Apr 2022

Keywords

  • Coronary artery disease
  • Cost-effectiveness
  • Depression
  • Exercise therapy
  • Ireland
  • Psychosocial intervention

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