Augmentation with either aripiprazole or bupropion for depression treatment may be more cost-effective than switching to bupropion, according to study data published in the Journal of Clinical Psychiatry.
Investigators conducted a cost-effectiveness analysis as part of the Veterans Affairs Augmentation and Switching Treatments for Improving Depression Outcomes trial, in which patients at 35 Veterans Affairs medical centers with suboptimal depression treatment response were randomly assigned to 12 weeks of an alternate treatment regimen. Patients were randomly assigned to standard antidepressant therapy augmented with aripiprazole, standard antidepressant therapy augmented with bupropion, or a switch to bupropion. Remission was captured according to the 16-item Quick Inventory of Depression Symptomatology-Clinician Rated.
As primary outcome measures, investigators calculated incremental cost-effectiveness ratios (ICER) by comparing costs per remission and costs per quality-adjusted life-year. Patients enrolled in the trial (n=1522) were of mean age 54.4±12.2, and the majority (84% to 87%) were men. Each treatment arm had similar depression duration, severity, and symptomatology. At 12 weeks, the percentage of patients in remission was 29% in the aripiprazole augmentation arm, followed by 27% and 22% in the bupropion augmentation and bupropion switch arms, respectively. The ICER for switching to bupropion compared with bupropion augmentation was −$640 per remission (95% CI, −$5770 to $3008). Moreover, the ICER for aripiprazole augmentation vs switching to bupropion was $1074 per remission (95% CI, $47 to $5022). The ICER for aripiprazole augmentation vs bupropion augmentation was $5094 per remission (95% CI, −$34,027 to $32,774). As such, aripiprazole augmentation and bupropion augmentation each dominated switching to bupropion in terms of cost-effectiveness; however, no additional significant differences between treatment arms were observed in quality-adjusted life-years, mental healthcare costs, employment, or other social adjustment outcomes.
These data support augmentation with aripiprazole or bupropion over switching to bupropion as more cost-effective for depression treatment. Of note, the high remission rate observed in the aripiprazole augmentation arm was not associated with greater improvements in other outcome measures, including employment and social adjustment. Thus, the researchers recommended that further research investigate the adverse events profile of aripiprazole augmentation therapy.
Yoon J, Zisook S, Park A, Johnson GR, Scrymgeour A, Mohamed S. Comparing cost-effectiveness of aripiprazole augmentation with other “next-step” depression treatment strategies: a randomized clinical trial. J Clin Psychiatry. 2019;80(1):18m12294.