Prior work identified 6 key value elements (attributes of treatment and desired outcomes) for individuals living with major depressive disorder (MDD) in managing their condition: mode of treatment, time to treatment helpfulness, MDD relief, quality of work, interaction with others, and affordability. The objective of our study was to identify whether previous cost-effectiveness analyses (CEAs) for MDD treatment addressed any of these value elements. A secondary objective was to identify whether any study engaged patients, family members, and caregivers in the model development process.
We conducted a systematic literature review to identify published model-based CEAs. We compared the elements of the published studies with the MDD patient value elements elicited in prior work to identify gaps and areas for future research.
Of 86 published CEAs, we found that 7 included patient out-of-pocket costs, and 32 included measures of productivity, which were both priorities for individuals with MDD. We found that only 2 studies elicited measures from patients for their model, and 2 studies engaged patients in the modeling process.
Published CEA models for MDD treatment do not regularly include value elements that are a priority for this patient population nor do they include patients in their modeling process. Flexible models that can accommodate elements consistent with patient experience are needed, and a multistakeholder engagement approach would help accomplish this.
This study looked at whether past research evaluating the costs and benefits of treatments for major depressive disorder considered aspects of care that matter most to patients. Earlier studies had already identified 6 important treatment features valued by people living with major depressive disorder: (1) how treatment is delivered, (2) how quickly it begins to help, (3) relief of depression symptoms, (4) quality of work life, (5) relationships with others, and (6) affordability.
The main goal of this research was to see if existing cost-effectiveness analyses included any of these 6 value elements. A second goal was to find out whether any of the studies had involved patients, family members, or caregivers when designing their evaluation models. The researchers conducted a systematic review of published cost-effectiveness analyses of major depressive disorder treatments. They compared each study’s content against the 6 patient-informed value elements to identify which aspects were covered and which were overlooked.
Out of 86 cost-effectiveness analyses reviewed, only 7 studies considered patients’ out-of-pocket costs, and 32 included productivity-related outcomes. Just 2 studies directly collected information from patients for their models, and another 2 involved patients in the modeling process. Most cost-effectiveness analyses mainly focused on clinical trial results, such as remission and relapse, rather than broader impacts like work quality or social connections.
The findings show that current cost-effectiveness analyses often miss important patient priorities and rarely engage patients in shaping the models. To better reflect the real experiences and needs of people living with major depressive disorder, future evaluations should use flexible approaches that incorporate patient perspectives. Involving patients and other stakeholders could help create more meaningful and relevant assessments to inform healthcare decisions.