Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .
Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor-resistant depression: treatment of SSRI-resistant depression in adolescents trial findings.
CONTEXT Many youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors ( SSRIs ) , and this is associated with higher costs . More effective treatment for these youth may be cost-effective . OBJECTIVE To evaluate the incremental cost-effectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI . DESIGN R and omized controlled trial . SETTING Six US academic and community clinics . PATIENTS Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression . INTERVENTION Participants were r and omly assigned to ( 1 ) switch to a different medication only or ( 2 ) switch to a different medication plus cognitive behavior therapy . MAIN OUTCOME MEASURES Clinical outcomes were depression-free days ( DFDs ) , depression-improvement days ( DIDs ) , and quality -adjusted life-years based on DFDs ( DFD-QALYs ) . Costs of intervention , non protocol services , and families were included . RESULTS Combined treatment achieved 8.3 additional DFDs ( P = .03 ) , 0.020 more DFD-QALYs ( P = .03 ) , and 11.0 more DIDs ( P = .04 ) . Combined therapy cost $ 1633 more ( P = .01 ) . Cost per DFD was $ 188 ( incremental cost-effectiveness ratio [ ICER ] = $ 188 ; 95 % confidence interval [ CI ] , -$22 to $ 1613 ) , $ 142 per DID ( ICER = $ 142 ; 95 % CI , -$14 to $ 2529 ) , and $ 78,948 per DFD-QALY ( ICER = $ 78,948 ; 95 % CI , -$9261 to $ 677,448 ) . Cost-effectiveness acceptability curve analyses suggest a 61 % probability that combined treatment is more cost-effective at a willingness to pay $ 100,000 per QALY . Combined treatment had a higher net benefit for subgroups of youth without a history of abuse , with lower levels of hopelessness , and with comorbid conditions . CONCLUSIONS For youth with SSRI-resistant depression , combined treatment decreases the number of days with depression and is more costly . Depending on a decision maker 's willingness to pay , combined therapy may be cost-effective , particularly for some subgroups . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00018902
Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse .
To up date a comparative effectiveness review ( 1980–2011 ) of treatments for adolescents whose depressive episode or disorder ( MDE/MDD ) did not respond to one or more trials of SSRI antidepressants .