RESPONSE TO NEFAZODONE, CBASP, AND COMBINED THERAPY- IMPLICATIONS FOR CHRONIC DEPRESSION SEVERITY, FUNCTIONAL STATUS AND ECONOMIC OUTCOMES
Author(s)
Crown WH1, Berndt E2, Finkelstein S2, Russell J3, Ling D1, White A1, Koran L4, Dunner D5, Kocsis J6, Kornstein S7, Borian F8, 1The MEDSTAT Group, Cambridge, MA, USA; 2Massachusetts Institute of Technology, Cambridge, MA, USA; 3University of Texas Medical Branch, Galveston, TX, USA; 4Stanford University School of Medicine, Stanford, CA, USA; 5University of Washington, Seattle, WA, USA; 6Cornell University Medical College, New York, NY, USA; 7Medical College of Virginia, Richmond, VA, USA; 8Bristol-Myers Squibb Company, Plainsboro, NJ, USA
Results from a recent trial suggest that combination of nefazodone and Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is more efficacious than either modality alone in the treatment of chronic depression. OBJECTIVES: This analysis examines the relationship between treatment modality, clinical measures of depression severity, measures of patient functioning, and economic outcomes. METHODS: Outcomes data from the 12-week acute phase of a 12-site trial investigating the therapeutic efficacy of nefazodone, CBASP and their combination using symptom and functional metrics are combined with medical claims data encompassing 1.4 million lives (MarketScan, The MEDSTAT Group) used to attribute costs to clinical interventions. Economic benefits of treatment are calculated by multiplying patient income and proportional changes in functional capacity. Modified versions of the Social Adjustment Scale (SAS), SF-36, and L.I.F.E. are used to determine functional capacity. RESULTS: Work impairment improved significantly for all groups, but is greatest for combination therapy (p<0.02). This pattern is also observed for the overall SAS score (p<0.001). Baseline to week 4 differences in overall SAS demonstrate significantly greater improvement for nefazodone mono-therapy compared to CBASP mono-therapy (p=0.032). Conservative estimates of mean direct treatment costs per patient irrespective of response are $770 (nefazodone), $1800 (CBASP) and $2500 (combination). Estimated mean direct treatment costs per acute responder are $1700 (nefazodone), $4000 (CBASP), and $3400 (combination). Multivariate results are presented that highlight the interrelationships of treatment modality, disease severity (HAM-D), functional status (SAS, SF-36, and L.I.F.E.) and costs of treatment. CONCLUSIONS: Combination treatment is most efficacious. Direct treatment cost per acute responder is lowest for treatments using nefazodone. Further cost-effectiveness results incorporating variation in time-to-response, other direct costs, and economic benefits associated with treatment will also be presented.
Conference/Value in Health Info
2000-05, ISPOR 2000, Arlington, VA, USA
Value in Health, Vol. 3, No. 2 (March/April 2000)
Code
PMH38
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
Mental Health