Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
Received 28 July 2018
Accepted for publication 3 January 2019
Published 14 March 2019 Volume 2019:11 Pages 257—270
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Dean Smith
Si-Tien Wang,1 Ian M Anderson,2 Dominic Mitchell,3 Scott J Johnson,1 Aki Shiozawa4,5
1Medicus Economics, LLC, Boston, MA, USA; 2Neuroscience and Psychiatry Unit, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK; 3Medicus Economics, LLC, Repentigny, QC, Canada; 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 5Global Outcome Research, Takeda Pharmaceuticals International, Inc., Deerfield, IL, USA
Background: Patients with treatment-resistant major depressive disorder (TRD) have limited treatment options. We developed an early stage cost-effectiveness model of TRD to explore the potential value of a hypothetical monotherapy relative to the standard of care (SOC). The relative impacts of the monotherapy’s three differentiating features over SOC are explored: efficacy advantage, tolerability advantage, and price premium.
Methods: We adapted an existing economic model of TRD to evaluate the cost-effectiveness of a hypothetical monotherapy for TRD with a 25% efficacy advantage, a 10% tolerability advantage, and a 50% price premium over SOC (selective serotonin reuptake inhibitor plus atypical antipsychotics [SSRI + AAP]). The model is a hybrid of a decision tree that captures patients’ outcomes after an 8-week acute treatment phase and a Markov model that simulates patients’ depression course through a 10-month maintenance phase. Sensitivity (deterministic and probabilistic) and scenario analyses were conducted to characterize the relative impacts of the monotherapy’s three differentiating features over SOC.
Results: Over the 12-month time horizon, the hypothetical monotherapy is shown to dominate SOC; it generates lower costs and higher quality-adjusted life years in comparison to SSRI + AAP. Sensitivity and scenario analyses showed that this dominance depends largely on the monotherapy’s efficacy and tolerability advantages over SOC. Specifically, a monotherapy with ≥ 12% efficacy or ≥70% tolerability advantage (and a 50% price premium) will always be superior to SSRI + AAP. Between these two extremes, most profiles, nonetheless, generate incremental cost-utility ratios for the monotherapy, which fall below common payer willingness-to-pay thresholds.
Conclusion: Our adaptation of an existing economic model of TRD provides a flexible platform for researchers to evaluate the efficacy/tolerability improvements required for a successful new TRD product and for decision-makers to assess the cost-effectiveness impact of uncertainties inherent in early stage product development in TRD.
Keywords: treatment-resistant depression, cost-effectiveness, pharmacotherapy
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]