OBJECTIVES:

Our recent study in individuals with major depressive disorder (MDD) elicited six prioritized attributes in selecting treatments to manage their condition: Treatment Mode, Time to Treatment Effect, MDD Relief, Quality of Work, Interaction with Others, and Affordability. This study aims to identify whether previous cost-effectiveness analyses (CEAs) in MDD addressed these patient-important attributes, whether patients were engaged in the modeling process, and whether patient preferences for treatment attributes were incorporated into the economic evaluations.

METHODS:

Using Embase and MEDLINE, we identified published, full-length original research describing model-based cost-effectiveness analysis for MDD treatment. We extracted study characteristics (e.g., model perspective), and whether and how models addressed the aforementioned patient-important attributes. Additionally, we identified whether patients, caregivers or families were included in the modeling process, and whether any model inputs were elicited directly from people with MDD. We summarized the extracted model attributes and synthesized how models addressed the listed patient priorities.

RESULTS:

Of the 1,369 abstracts screened; 253 were included in full-text review; 76 met the inclusion criteria. Publication year ranged from 1995-2020; 33 studies reported a societal perspective; 20 compared multiple treatment modes. Time to treatment effect was reflected in model cycle length (range: 4 weeks to 1 year). 34 studies addressed work productivity and 9 patient out-of-pocket costs. Two studies elicited inputs directly from patients. Interaction with others was not explicitly modeled in any study. Two papers documented formal value assessments and reported patient stakeholder participation in the process (e.g., model scoping).

CONCLUSIONS:

While productivity and out-of-pocket costs are often included in models from the societal perspective, very few studies addressed other attributes important to patients, used patient-derived inputs, or included patients in the evaluation process. Methods to incorporate patients and their valued elements as part of a value assessment are needed.