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Cost-Utility Analysis of Discontinuing Antidepressants in England Primary Care Patients Compared with Long-Term Maintenance: The ANTLER Study

Cost-Utility Analysis of Discontinuing Antidepressants in England Primary Care Patients Compared with Long-Term Maintenance: The ANTLER Study
Cost-Utility Analysis of Discontinuing Antidepressants in England Primary Care Patients Compared with Long-Term Maintenance: The ANTLER Study

BACKGROUND: Depression is a common mental health condition with considerable negative impact on health and well-being. Although antidepressants are recommended as first-line treatment, there is limited evidence regarding the cost effectiveness of long-term maintenance antidepressants for preventing relapse.

OBJECTIVES: Our objective was to calculate the mean incremental costs and quality-adjusted life-years (QALYs) over 12 months of discontinuing long-term antidepressant medication in well patients compared with maintenance, using patient-level trial data.

METHODS: We conducted a cost-utility analysis of 478 participants from 150 UK general practices recruited to a randomised, double-blind trial (ANTLER). QALYs were calculated from EQ-5D-5L and 12-Item Short Form survey (SF-12) results, with primary analysis using the EQ-5D-5L value set for England. Resource use was collected from primary care patient electronic medical records and self-completed questionnaires capturing mental-health-related resource use. Costs were calculated by applying standard UK unit costs to resource use. Adjustments were made for baseline variables.

RESULTS: Participants randomised to discontinuation had significantly worse utility scores at 3 months (- 0.032; 95% confidence interval [CI] - 0.053 to - 0.011) but no significant difference in QALYs (- 0.011; 95% CI - 0.026 to 0.003) or costs (£3.11; 95% CI - 41.28 to 47.50) at 12 months. The probability that discontinuation was cost effective compared with maintenance was 12.9% at a threshold of £20,000 per QALY gained.

CONCLUSIONS: Discontinuation of antidepressants was unlikely to be cost effective compared with maintenance for currently well patients on long-term antidepressants. However, this analysis provides no information on the wider impact of antidepressants. Our findings provide information on the potential impact of discontinuing long-term maintenance antidepressants and facilitate improving guidance for shared patient-clinician decision making.

TRIAL REGISTRATION: EudraCT number 2015-004210-26; ISRCTN number ISRCTN15969819.

1179-1896
Clarke, Caroline S
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Duffy, Larisa
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Lewis, Glyn
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Freemantle, Nick
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Gilbody, Simon
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Kendrick, Tony
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Kessler, David
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King, Michael
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Lanham, Paul
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Mangin, Derelie
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Moore, Michael
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Nazareth, Irwin
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Wiles, Nicola
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Marston, Louise
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Hunter, Rachael Maree
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Clarke, Caroline S
b861b54c-86ad-4006-a2f2-a737ddeff32f
Duffy, Larisa
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Lewis, Glyn
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Freemantle, Nick
8182a4ad-e20e-4aea-b5f7-62b170845d1e
Gilbody, Simon
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Kendrick, Tony
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Kessler, David
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King, Michael
cf8c59d9-802d-45b8-8413-be0d41446c0d
Lanham, Paul
2bcf9c17-6c36-47a1-8714-3bc984ae4406
Mangin, Derelie
8ebee391-4c9d-4f3b-b569-da82e235a4b6
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Nazareth, Irwin
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Wiles, Nicola
fcec2769-de78-4b86-b9c1-eab754a02837
Marston, Louise
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Hunter, Rachael Maree
38cfc414-e271-4a60-ab65-6c821bedfd40

Clarke, Caroline S, Duffy, Larisa, Lewis, Glyn, Freemantle, Nick, Gilbody, Simon, Kendrick, Tony, Kessler, David, King, Michael, Lanham, Paul, Mangin, Derelie, Moore, Michael, Nazareth, Irwin, Wiles, Nicola, Marston, Louise and Hunter, Rachael Maree (2021) Cost-Utility Analysis of Discontinuing Antidepressants in England Primary Care Patients Compared with Long-Term Maintenance: The ANTLER Study. Applied Health Economics and Health Policy. (doi:10.1007/s40258-021-00693-x).

Record type: Article

Abstract

BACKGROUND: Depression is a common mental health condition with considerable negative impact on health and well-being. Although antidepressants are recommended as first-line treatment, there is limited evidence regarding the cost effectiveness of long-term maintenance antidepressants for preventing relapse.

OBJECTIVES: Our objective was to calculate the mean incremental costs and quality-adjusted life-years (QALYs) over 12 months of discontinuing long-term antidepressant medication in well patients compared with maintenance, using patient-level trial data.

METHODS: We conducted a cost-utility analysis of 478 participants from 150 UK general practices recruited to a randomised, double-blind trial (ANTLER). QALYs were calculated from EQ-5D-5L and 12-Item Short Form survey (SF-12) results, with primary analysis using the EQ-5D-5L value set for England. Resource use was collected from primary care patient electronic medical records and self-completed questionnaires capturing mental-health-related resource use. Costs were calculated by applying standard UK unit costs to resource use. Adjustments were made for baseline variables.

RESULTS: Participants randomised to discontinuation had significantly worse utility scores at 3 months (- 0.032; 95% confidence interval [CI] - 0.053 to - 0.011) but no significant difference in QALYs (- 0.011; 95% CI - 0.026 to 0.003) or costs (£3.11; 95% CI - 41.28 to 47.50) at 12 months. The probability that discontinuation was cost effective compared with maintenance was 12.9% at a threshold of £20,000 per QALY gained.

CONCLUSIONS: Discontinuation of antidepressants was unlikely to be cost effective compared with maintenance for currently well patients on long-term antidepressants. However, this analysis provides no information on the wider impact of antidepressants. Our findings provide information on the potential impact of discontinuing long-term maintenance antidepressants and facilitate improving guidance for shared patient-clinician decision making.

TRIAL REGISTRATION: EudraCT number 2015-004210-26; ISRCTN number ISRCTN15969819.

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Accepted/In Press date: 19 October 2021
e-pub ahead of print date: 8 November 2021
Published date: 8 November 2021

Identifiers

Local EPrints ID: 452392
URI: http://eprints.soton.ac.uk/id/eprint/452392
ISSN: 1179-1896
PURE UUID: 0f8076ac-5c08-44c1-b772-b0c9f353744e
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 09 Dec 2021 17:55
Last modified: 12 Apr 2022 01:38

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Contributors

Author: Caroline S Clarke
Author: Larisa Duffy
Author: Glyn Lewis
Author: Nick Freemantle
Author: Simon Gilbody
Author: Tony Kendrick ORCID iD
Author: David Kessler
Author: Michael King
Author: Paul Lanham
Author: Derelie Mangin
Author: Michael Moore ORCID iD
Author: Irwin Nazareth
Author: Nicola Wiles
Author: Louise Marston
Author: Rachael Maree Hunter

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