Economic evaluation of an add-on module to reduce intrusive suicidal mental images in patients with depressive symptoms

Abstract

Background: Previous research demonstrated the effectiveness of an add-on module in reducing intrusive suicidal mental images in patients with elevated depression symptoms indicative of a depressive disorder. This study assessed the cost-effectiveness of combining this module with treatment as usual (TAU) versus TAU-alone. Research design and methods: A randomized controlled trial of 91 participants (46 add-on+TAU, 45 TAU). Cost-effectiveness was assessed over 12 months using quality-adjusted life years (QALYs) as the primary outcome. Healthcare, patient, and work-related costs were measured. Health-related quality of life was assessed using EQ-5D-5 L at baseline, and after 3, 6, 9, and 12 months. Results: The add-on+TAU group showed slightly higher QALYs (0.674) than TAU-group (0.630) after 12 months. From a societal perspective, the intervention yielded an incremental cost-effectiveness ratio of €137,285 per QALY gained (95% CI: -€7,338 to €15,656; QALY gain: 0.0274). Healthcare costs were higher in the add-on+TAU group, primarily due to increased outpatient mental care costs (including intervention costs of €524.02/participant). The intervention showed a 35% probability of cost-effectiveness at an €80,000 willingness-to-pay threshold. Conclusions: Although the add-on module reduced suicidal mental images, its cost-effectiveness remains uncertain. Modest QALY improvements did not justify increased healthcare and societal costs. Larger-scale studies with extended follow-up are needed. Clinical Trial Registration: The trial was prospectively registered in the Netherlands Trial Registry (No. NTR7563).