Use of cognitive therapy for relapse prevention in chronic depression. Cost-effectiveness study.

BACKGROUND There is a lack of data on the cost-effectiveness of relapse prevention in depression. METHOD A total of 158 subjects with partially remitted major depression despite adequate clinical treatment were randomly allocated to cognitive therapy in addition to antidepressants and clinical management v. antidepressants and clinical management alone. Relapse rates and health care resource utilisation were measured prospectively over 17 months. RESULTS Cumulative relapse rates in the cognitive therapy group were significantly lower than in the control group (29% v. 47%). The incremental cost incurred in subjects receiving cognitive therapy over 17 months (pound sterling 779; 95% CI pound sterling 387- pound sterling 1170) was significantly lower than the overall mean costs of cognitive therapy (pound sterling 1164; 95% CI pound sterling 1084- pound sterling 1244). The incremental cost-effectiveness ratio ranged from pound sterling 4328 to pound sterling 5027 per additional relapse prevented. CONCLUSIONS In individuals with depressive symptoms that are resistant to standard treatment, adjunctive cognitive therapy is more costly but more effective than intensive clinical treatment alone.