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dc.contributor.authorShearer, Jen
dc.contributor.authorLynch, TRen
dc.contributor.authorChamba, Ren
dc.contributor.authorClarke, Sen
dc.contributor.authorHempel, RJen
dc.contributor.authorKingdon, DGen
dc.contributor.authorO'Mahen, Hen
dc.contributor.authorRemington, Ben
dc.contributor.authorRushbrook, SCen
dc.contributor.authorRussell, ITen
dc.contributor.authorStanton, Men
dc.contributor.authorSwales, Men
dc.contributor.authorWatkins, Aen
dc.contributor.authorWhalley, Ben
dc.contributor.authorByford, Sen
dc.date.accessioned2019-07-31T08:57:51Z
dc.date.available2019-07-31T08:57:51Z
dc.date.issued2019-09en
dc.identifier.issn2056-4724en
dc.identifier.othere64en
dc.identifier.urihttp://hdl.handle.net/10026.1/14721
dc.description.abstract

<jats:sec id="S2056472419000577_sec_a1"><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S2056472419000577_sec_a2"><jats:title>Aims</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec id="S2056472419000577_sec_a3" sec-type="methods"><jats:title>Method</jats:title><jats:p>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 quality-adjusted life-years (QALYs), estimated using the EQ-5D-3L measure of health-related quality of life.</jats:p></jats:sec><jats:sec id="S2056472419000577_sec_a4" sec-type="results"><jats:title>Results</jats:title><jats:p>The additional cost of RO DBT plus TAU compared with TAU alone was £7048 and was associated with a difference of 0.032 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of £220 250 per QALY. This ICER was well above the National Institute for Health and Care Excellence (NICE) upper threshold of £30 000 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 £30 000 threshold.</jats:p></jats:sec><jats:sec id="S2056472419000577_sec_a5" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>In its current resource-intensive form, RO DBT is not a cost-effective use of resources in the UK NHS.</jats:p></jats:sec><jats:sec id="S2056472419000577_sec_a6"><jats:title>Declaration of interest</jats:title><jats:p>R.H. is co-owner and director of Radically Open Ltd, the RO DBT training and dissemination company. D.K. reports grants outside the submitted work from the National Institute for Health Research (NIHR). T.L. receives royalties from New Harbinger Publishing for sales of RO DBT treatment manuals, speaking fees from Radically Open Ltd, and a grant outside the submitted work from the Medical Research Council. He was co-director of Radically Open Ltd between November 2014 and May 2015 and is married to Erica Smith-Lynch, the principal shareholder and one of two directors of Radically Open Ltd. H.O'M. reports personal fees outside the submitted work from the Charlie Waller Institute and Improving Access to Psychological Therapy. S.R. provides RO DBT supervision through her company S C Rushbrook Ltd. I.R. reports grants outside the submitted work from NIHR and Health &amp;amp; Care Research Wales. M. Stanton reports personal fees outside the submitted work from British Isles DBT Training, Stanton Psychological Services Ltd and Taylor &amp;amp; Francis. M. Swales reports personal fees outside the submitted work from British Isles DBT Training, Guilford Press, Oxford University Press and Taylor &amp;amp; Francis. B.W. was co-director of Radically Open Ltd between November 2014 and February 2015.</jats:p></jats:sec>

en
dc.languageenen
dc.language.isoenen
dc.publisherCambridge University Press (CUP)en
dc.titleRefractory depression – cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trialen
dc.typeJournal Article
plymouth.issue05en
plymouth.volume5en
plymouth.journalBJPsych Openen
dc.identifier.doi10.1192/bjo.2019.57en
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/00 Groups by role
plymouth.organisational-group/Plymouth/00 Groups by role/Academics
plymouth.organisational-group/Plymouth/Faculty of Health: Medicine, Dentistry and Human Sciences
plymouth.organisational-group/Plymouth/Faculty of Health: Medicine, Dentistry and Human Sciences/School of Psychology
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA04 Psychology, Psychiatry and Neuroscience
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Centre for Brain, Cognition and Behaviour (CBCB)
plymouth.organisational-group/Plymouth/Research Groups/Centre for Brain, Cognition and Behaviour (CBCB)/Behaviour
dcterms.dateAccepted2019-07-07en
dc.rights.embargodate9999-12-31en
dc.identifier.eissn2056-4724en
dc.rights.embargoperiodNot knownen
rioxxterms.versionVoRen
rioxxterms.versionofrecord10.1192/bjo.2019.57en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-09en
rioxxterms.typeJournal Article/Reviewen


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