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Impact of Depression Relapse on Participant Quality of Life and Costs to the English NHS: Secondary Analysis from the Antler Study on Antidepressant Discontinuation in Well Patients in Primary Care

Speaker(s)

Clarke C1, Duffy L1, Lewis G1, Freemantle N1, Gilbody S2, Kendrick T3, Kessler D4, King M1, Lanham P5, Mangin D6, Moore M3, Nazareth I1, Wiles N4, Marston L1, Hunter RM1
1University College London, London, UK, 2University of York, York, UK, 3University of Southampton, Southampton, UK, 4University of Bristol, Bristol, UK, 5Patient and Public Involvement Collaborator, London, UK, 6McMaster University, Hamilton, ON, Canada

Presentation Documents

OBJECTIVES: Depression is a common and debilitating mental-health condition. Antidepressants are recommended as first-line treatment, often taken for months or years after a depressive episode. The ANTLER study investigated the impact of tapered discontinuation of medication in well patients, compared to maintenance treatment, to determine whether maintenance treatment prevented relapse. The objective was to calculate the impact on health-related quality-of-life (HRQoL) and English National Health Service (NHS) costs of experiencing a depression relapse, using ANTLER patient-level trial data.

METHODS: 478 participants from 150 England general practices were recruited to a randomised, double-blind trial (ANTLER). Utility scores were calculated from the EQ-5D-5L preference-based measure of HRQoL using the Value Set for England and crosswalk tariffs, and the Short-Form 12 (SF-6D tariff), collected every 3 months. Six-monthly costs were calculated by applying unit costs to resource use collected from primary care electronic records and self-completed questionnaires at baseline, 6 and 12 months. Relapse was assessed every 3 months using the retrospective Clinical Interview Schedule - Revised (rCIS-R) to identify the onset of a depressive episode over the previous 3 months. Adjustments included randomised group, baseline ANTLER medication, baseline disease severity and site.

RESULTS: Relapse corresponded to a significant reduction in HRQoL for that quarter, in all three utility tariffs, and increased primary care consultation costs by a mean of £28.31 (95% CI 12.62 to 44.00) per patient. There was no significant difference in self-reported costs (£5.76, 95% CI -14.97 to 26.49).

CONCLUSIONS: Depression relapse corresponded to significant reductions in HRQoL for patients. This agreed with previous work suggesting that generic preference-based measures are valid in common mental-health disorders, facilitating comparability with economic evaluations in other disease areas. This work also presents evidence of the cost of a depression relapse to the English NHS, an area where high-quality evidence has previously been lacking.

Code

EE214

Topic

Economic Evaluation, Patient-Centered Research, Study Approaches

Topic Subcategory

Clinical Trials, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Patient-reported Outcomes & Quality of Life Outcomes, Trial-Based Economic Evaluation

Disease

Drugs