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Open Access Research article

Cost-effectiveness of family psychoeducation to prevent relapse in major depression: Results from a randomized controlled trial

Shinji Shimodera1, Toshi A Furukawa25*, Yoshio Mino3, Kae Shimazu1, Atsushi Nishida4 and Shimpei Inoue1

Author Affiliations

1 Department of Neuropsychiatry, Kochi Medical School, Kohatsu, Okoh-cho, Kochi, 783-8505, Japan

2 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medical Sciences / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

3 Mino Clinic, Shimoishi, Kita-ku, Okayama, 700-0907, Japan

4 Department of Psychiatry & Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan

5 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medical Sciences / School of Public Health, Kyoto, Japan

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BMC Psychiatry 2012, 12:40  doi:10.1186/1471-244X-12-40

Published: 14 May 2012

Abstract

Background

Family psychoeducation is a relatively simple and straightforward intervention whose prophylactic effectiveness and cost-effectiveness is well-established for schizophrenia. We have recently demonstrated its effectiveness for unipolar depression, but its cost-effectiveness has never been examined. We hereby report a cost-effectiveness analysis alongside a randomized controlled trial in order to assess its cost-effectiveness for preventing relapse/recurrence in depression.

Methods

Fifty-seven patients diagnosed with major depression and undergoing its maintenance treatment, and their primary family members were randomized to treatment as usual (TAU) only or to TAU plus family psychoeducation, which consisted of four 2-hour multiple-family sessions consisting of didactic lectures about depression (30 minutes) and group discussion and problem solving (60–90 minutes). The economic analyses were undertaken from the perspective of the National Health Insurance (NHI), assuming the most reasonable price of US$50 per psychoeducation session per patient. The main outcome measures included relapse-free days and direct costs to the NHI.

Results

The intervention group enjoyed 272 (SD: 7.1) relapse-free days, while the control group spent 214 (SD: 90.8) relapse-free days (Cox proportional hazard ratio = 0.17, 95%CI: 0.04 to 0.75, p = 0.002). Cost-effectiveness acceptability curves suggested that the family psychoeducation has 90% or more chances of being cost-effective if the decision-maker is prepared to pay US$20 for one additional relapse-free day. This cost-effectiveness finding was robust when the price for family psychoeducation ranged between 50% to 150% of the baseline scenario in sensitivity analyses. If a relapse-free day is considered to be worth $30 or more, all the pricing scenarios have a close to 100% probability of being cost-effective.

Conclusion

Family psychoeducation is effective in the relapse prevention of depression and is highly likely to be cost-effective if a relapse-free day is valued as US$20 or more.

Trial registration

UMIN-CTR (UMIN000005555)