Journal of the American Academy of Child & Adolescent Psychiatry
New ResearchRelative Cost-Effectiveness of Treatments for Adolescent Depression: 36-Week Results From the TADS Randomized Trial
Section snippets
Method
The TADS was a multisite, randomized, 36-week clinical trial comparing the effectiveness of FLX, CBT, and combination treatment for the treatment of adolescents with major depression. For the first 12 weeks (stage 1), clinical management with pill placebo was also included, allowing for a double-blind comparison with FLX. Active treatment responders or partial responders, defined as at least minimally improved on a clinician-assigned Clinical Global Impressions score, progressed to a 6-week
Results
The average age of study participants at baseline was just younger than 15 years, and 55% were female subjects (Table 1). The average CDRS-R score decreased from a baseline average of 60 to a 36-week average of 29. The average number of DFDs over the 252-day interval was 135, ranging from 0 to 238, yielding an average DFD-QALY of 0.56 out of a potential maximum of 0.69 for 36 weeks. The exploratory QALY developed from the PQ-LES-Q had a similar average of 0.58. The mean HoNOSCA score dropped
Discussion
In the TADS, the accelerated response from medication treatment7, 8 combined with the lower costs of external services for CBT treatments ($2,700–$3,100 for combination treatment or CBT, respectively, as compared with $5,400 for FLX alone) yielded evidence favoring combination treatment with a high level of certainty (>90%) over FLX. No evidence of differential cost-effectiveness between CBT and FLX was detected. Increased rates of suicidal events in depressed patients treated with newer
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Cited by (0)
This work was supported by contract N01 MH80008 from the National Institute of Mental Health to Duke University Medical Center (John S. March, Principal Investigator). Additional support was received by M.E.D. under K01-MH065639.
Dr. Domino had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.