Análise de custo-efetividade da eletroconvulsoterapia no tratamento da depressão resistente
Análise de custo-efetividade da eletroconvulsoterapia no tratamento da depressão resistente
Data
2023
Autores
Campos, Paula Gama Muniz de
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A depressão é a principal causa global de incapacidade. Estima-se uma
prevalência de 3,8% na população mundial, sendo mais comum em mulheres (4,5%)
do que em homens (3%). Diversas modalidades terapêuticas possuem evidências de
eficácia no tratamento do transtorno depressivo, inclusive a eletroconvulsoterapia. A
ausência de resposta a dois ou mais medicamentos antidepressivos caracteriza a
resistência ao tratamento. Apesar da eletroconvulsoterapia ter indicações bem
definidas no transtorno depressivo, ainda não houve sua incorporação no rol de
procedimentos de cobertura obrigatória da Agência Nacional de Saúde Suplementar.
Objetivos: Realizar uma análise de custo-efetividade da eletroconvulsoterapia,
associada ao tratamento com antidepressivos, em comparação ao tratamento
convencional com antidepressivos em pacientes adultos com transtorno depressivo
resistente. Método: Foi realizado um modelo de Markov com ciclo de 6 semanas para
estimar a razão de custo-efetividade incremental da intervenção eletroconvulsoterapia
associada a medicamentos antidepressivos em comparação a estratégia de terapia
convencional com medicamentos antidepressivos, sob perspectiva de uma operadora
de saúde de autogestão e com horizonte temporal de um ano. QALY foi a medida de
efetividade. Foram efetuadas análises de sensibilidade determinística e probabilística.
Resultados: A análise de custo-efetividade do modelo demonstrou uma razão de
custo efetividade incremental de R$ 2.460,25 por QALY na estratégia de
eletroconvulsoterapia. O valor se encontra abaixo do limiar de custo-efetividade
definido no Brasil (R$ 40.000,00 por QALY) caracterizando a estratégia como custo efetiva. A análise determinística demonstrou que os parâmetros que mais impactaram
o modelo foram o valor de utilidade dos indivíduos no estado de resposta, o custo da
eletroconvulsoterapia e a probabilidade de eficácia da eletroconvulsoterapia. A análise
probabilística demonstrou que 94,3% das simulações realizadas estão abaixo do
limiar. Conclusões: A ECT associada a medicamentos antidepressivos demonstrou
ser uma estratégia custo-efetiva em comparação a terapia com medicamentos
antidepressivos em pacientes com depressão resistente sob a perspectiva de uma
operadora de saúde de autogestão.
Background: Depression is the global leading cause of disability. It is estimated a prevalence of 3.8% in the world population and is more frequent in women (4.5%) than in men (3%). Several therapeutic modalities are effective in the treatment of depressive disorder, including electroconvulsive therapy. The lack of response to two or more antidepressant drugs characterizes treatment resistance. Although electroconvulsive therapy has well-defined indications in depressive disorders, it has not yet been incorporated into the list of mandatory coverage of medical procedures by the National Supplementary Health Agency. Objectives: To perform a cost-effectiveness analysis of electroconvulsive therapy associated with antidepressant medications compared to conventional antidepressant treatment in adult patients with resistant depressive disorder. Methods: A Markov model with a 6-week cycle was performed to estimate the incremental cost-effectiveness ratio of the electroconvulsive therapy intervention associated with antidepressant medications compared to the conventional therapy strategy with antidepressant medications, from the perspective of a self-management healthcare provider and with a time horizon of one year. QALY was the measure of effectiveness. Deterministic and probabilistic sensitivity analyzes were performed. Results: The cost-effectiveness analysis of the model demonstrated an incremental cost-efectiveness ratio of BRL 2,460.25 per QALY in the electroconvulsive therapy strategy. The value is below the cost-effectiveness threshold defined in Brazil (BRL 40,000.00 per QALY), showing that the strategy is cost-effective. The deterministic analysis demonstrated that the parameters that most affected the incremental cost effectiveness ratio value were the utility of individuals in the response state, the cost of electroconvulsive therapy and the probability of effectiveness of electroconvulsive therapy strategy. The probabilistic analysis showed that 94.3% of the simulations performed are below the threshold. Conclusions: Electroconvulsive therapy associated with antidepressant medications proved to be a cost-effective strategy compared to antidepressant medication therapy in patients with resistant depression from the perspective of a self-managed healthcare provider.
Background: Depression is the global leading cause of disability. It is estimated a prevalence of 3.8% in the world population and is more frequent in women (4.5%) than in men (3%). Several therapeutic modalities are effective in the treatment of depressive disorder, including electroconvulsive therapy. The lack of response to two or more antidepressant drugs characterizes treatment resistance. Although electroconvulsive therapy has well-defined indications in depressive disorders, it has not yet been incorporated into the list of mandatory coverage of medical procedures by the National Supplementary Health Agency. Objectives: To perform a cost-effectiveness analysis of electroconvulsive therapy associated with antidepressant medications compared to conventional antidepressant treatment in adult patients with resistant depressive disorder. Methods: A Markov model with a 6-week cycle was performed to estimate the incremental cost-effectiveness ratio of the electroconvulsive therapy intervention associated with antidepressant medications compared to the conventional therapy strategy with antidepressant medications, from the perspective of a self-management healthcare provider and with a time horizon of one year. QALY was the measure of effectiveness. Deterministic and probabilistic sensitivity analyzes were performed. Results: The cost-effectiveness analysis of the model demonstrated an incremental cost-efectiveness ratio of BRL 2,460.25 per QALY in the electroconvulsive therapy strategy. The value is below the cost-effectiveness threshold defined in Brazil (BRL 40,000.00 per QALY), showing that the strategy is cost-effective. The deterministic analysis demonstrated that the parameters that most affected the incremental cost effectiveness ratio value were the utility of individuals in the response state, the cost of electroconvulsive therapy and the probability of effectiveness of electroconvulsive therapy strategy. The probabilistic analysis showed that 94.3% of the simulations performed are below the threshold. Conclusions: Electroconvulsive therapy associated with antidepressant medications proved to be a cost-effective strategy compared to antidepressant medication therapy in patients with resistant depression from the perspective of a self-managed healthcare provider.
Description
Palavras-chave
eletroconvulsoterapia, depressão, custo-efetividade, electroconvulsive therapy, depression, cost-effectiveness
Citação
Campos PGM. Análise de custo-efetividade da eletroconvulsoterapia no tratamento da depressão resistente. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2023