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Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression

BACKGROUND: Patients with treatment-resistant major depressive disorder (TRD) have limited treatment options. We developed an early stage cost-effectiveness model of TRD to explore the potential value of a hypothetical monotherapy relative to the standard of care (SOC). The relative impacts of the m...

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Autores principales: Wang, Si-Tien, Anderson, Ian M, Mitchell, Dominic, Johnson, Scott J, Shiozawa, Aki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421973/
https://www.ncbi.nlm.nih.gov/pubmed/30936731
http://dx.doi.org/10.2147/CEOR.S181718
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author Wang, Si-Tien
Anderson, Ian M
Mitchell, Dominic
Johnson, Scott J
Shiozawa, Aki
author_facet Wang, Si-Tien
Anderson, Ian M
Mitchell, Dominic
Johnson, Scott J
Shiozawa, Aki
author_sort Wang, Si-Tien
collection PubMed
description BACKGROUND: Patients with treatment-resistant major depressive disorder (TRD) have limited treatment options. We developed an early stage cost-effectiveness model of TRD to explore the potential value of a hypothetical monotherapy relative to the standard of care (SOC). The relative impacts of the monotherapy’s three differentiating features over SOC are explored: efficacy advantage, tolerability advantage, and price premium. METHODS: We adapted an existing economic model of TRD to evaluate the cost-effectiveness of a hypothetical monotherapy for TRD with a 25% efficacy advantage, a 10% tolerability advantage, and a 50% price premium over SOC (selective serotonin reuptake inhibitor plus atypical antipsychotics [SSRI + AAP]). The model is a hybrid of a decision tree that captures patients’ outcomes after an 8-week acute treatment phase and a Markov model that simulates patients’ depression course through a 10-month maintenance phase. Sensitivity (deterministic and probabilistic) and scenario analyses were conducted to characterize the relative impacts of the monotherapy’s three differentiating features over SOC. RESULTS: Over the 12-month time horizon, the hypothetical monotherapy is shown to dominate SOC; it generates lower costs and higher quality-adjusted life years in comparison to SSRI + AAP. Sensitivity and scenario analyses showed that this dominance depends largely on the monotherapy’s efficacy and tolerability advantages over SOC. Specifically, a monotherapy with ≥ 12% efficacy or ≥70% tolerability advantage (and a 50% price premium) will always be superior to SSRI + AAP. Between these two extremes, most profiles, nonetheless, generate incremental cost-utility ratios for the monotherapy, which fall below common payer willingness-to-pay thresholds. CONCLUSION: Our adaptation of an existing economic model of TRD provides a flexible platform for researchers to evaluate the efficacy/tolerability improvements required for a successful new TRD product and for decision-makers to assess the cost-effectiveness impact of uncertainties inherent in early stage product development in TRD.
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spelling pubmed-64219732019-04-01 Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression Wang, Si-Tien Anderson, Ian M Mitchell, Dominic Johnson, Scott J Shiozawa, Aki Clinicoecon Outcomes Res Original Research BACKGROUND: Patients with treatment-resistant major depressive disorder (TRD) have limited treatment options. We developed an early stage cost-effectiveness model of TRD to explore the potential value of a hypothetical monotherapy relative to the standard of care (SOC). The relative impacts of the monotherapy’s three differentiating features over SOC are explored: efficacy advantage, tolerability advantage, and price premium. METHODS: We adapted an existing economic model of TRD to evaluate the cost-effectiveness of a hypothetical monotherapy for TRD with a 25% efficacy advantage, a 10% tolerability advantage, and a 50% price premium over SOC (selective serotonin reuptake inhibitor plus atypical antipsychotics [SSRI + AAP]). The model is a hybrid of a decision tree that captures patients’ outcomes after an 8-week acute treatment phase and a Markov model that simulates patients’ depression course through a 10-month maintenance phase. Sensitivity (deterministic and probabilistic) and scenario analyses were conducted to characterize the relative impacts of the monotherapy’s three differentiating features over SOC. RESULTS: Over the 12-month time horizon, the hypothetical monotherapy is shown to dominate SOC; it generates lower costs and higher quality-adjusted life years in comparison to SSRI + AAP. Sensitivity and scenario analyses showed that this dominance depends largely on the monotherapy’s efficacy and tolerability advantages over SOC. Specifically, a monotherapy with ≥ 12% efficacy or ≥70% tolerability advantage (and a 50% price premium) will always be superior to SSRI + AAP. Between these two extremes, most profiles, nonetheless, generate incremental cost-utility ratios for the monotherapy, which fall below common payer willingness-to-pay thresholds. CONCLUSION: Our adaptation of an existing economic model of TRD provides a flexible platform for researchers to evaluate the efficacy/tolerability improvements required for a successful new TRD product and for decision-makers to assess the cost-effectiveness impact of uncertainties inherent in early stage product development in TRD. Dove Medical Press 2019-03-14 /pmc/articles/PMC6421973/ /pubmed/30936731 http://dx.doi.org/10.2147/CEOR.S181718 Text en © 2019 Wang et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Wang, Si-Tien
Anderson, Ian M
Mitchell, Dominic
Johnson, Scott J
Shiozawa, Aki
Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
title Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
title_full Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
title_fullStr Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
title_full_unstemmed Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
title_short Cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
title_sort cost-effectiveness model for a hypothetical monotherapy vs standard of care in adult patients with treatment-resistant depression
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421973/
https://www.ncbi.nlm.nih.gov/pubmed/30936731
http://dx.doi.org/10.2147/CEOR.S181718
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