Cost-Effectiveness Analysis for Antidepressants and Cognitive Behavioral Therapy for Major Depression in Thailand

ObjectiveTo determine the cost-effectiveness of fluoxetine and cognitive-behavioral therapy (CBT) for major depression in Thailand.MethodsA microsimulation model was developed to describe the variation in course of disease between individuals. Model inputs included Thai data on disease parameters and costs while impact measures were derived from a systematic review and meta-analysis of the international literature. Fluoxetine as the cheapest antidepressant drug in Thailand was analyzed for treatment of episodes plus a 6-month continuation phase and for maintenance treatment over 5 years of follow-up. CBT was analyzed for episodic treatment and for 5-year maintenance treatment. Results are presented as cost (Thai bahts) per disability-adjusted life-year (DALY) averted, compared with a “do-nothing” scenario.ResultsThe cost-effectiveness ratios of all interventions were below 1 time Thailand's gross domestic product of 110,000 bahts per capita. The uncertainty ranges around the cost-effectiveness ratios overlap: maintenance treatment with CBT 11,000 bahts per DALY (8,000–14,000); episodic treatment with CBT 23,000 bahts per DALY (10,000–36,000); episodic plus continuation drug treatment 33,000 bahts per DALY (26,000–44,000); maintenance drug treatment 38,000 bahts per DALY (30,000–48,000); and episodic drug treatment 42,000 bahts per DALY (32,000–57,000).ConclusionsCBT and generic fluoxetine are cost-effective treatment options for both episodic and maintenance treatment of major depression in Thailand. Maintenance treatment has the greatest potential of health gain.