Refractory depression - cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial.

Background Refractory depression is a major contributor to the economic burden of depression. Radically open dialectical behaviour therapy (RO DBT) is an unevaluated new treatment targeting overcontrolled personality, common in refractory depression, but it is not yet known whether the additional expense of RO DBT is good value for money. Aims To estimate the cost-effectiveness of RO DBT plus treatment as usual (TAU) compared with TAU alone in people with refractory depression (trial registration: ISRCTN85784627). Method We undertook a cost-effectiveness analysis alongside a randomised trial evaluating RO DBT plus TAU versus TAU alone for refractory depression in three UK secondary care centres. Our economic evaluation, 12 months after randomisation, adopted the perspective of the UK National Health Service (NHS) and personal social services. It evaluated cost-effectiveness by comparing the net cost of RO DBT with the net gain in qualityadjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life. Results The additional cost of RO DBT plus TAU compared with TAU alone was 7048 pound and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of 220 pound 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of 30 pound 000 per QALY. A cost-effectiveness acceptability curve indicated that RO DBT had a zero probability of being cost-effective compared with TAU at the NICE 30 pound 000 threshold. Conclusions In its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.