Economic evaluation of St. John's Wort (Hypericum perforatum) for the treatment of mild to moderate depression

School of Population Health, University of Queensland, Herston Road Herston, QLD 4006, Australia. Electronic address: .
Journal of Affective Disorders (Impact Factor: 3.38). 01/2013; 148(2-3). DOI: 10.1016/j.jad.2012.11.064
Source: PubMed


BACKGROUND: The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with Complementary and Alternative Medicines. Clinical controlled trials have found St. John's wort to be as effective as antidepressants in the treatment of mild to moderate depression. The objective of this study was to develop a model to assess the cost-effectiveness of St. John's wort based on this evidence. METHODS: A Markov model was constructed to estimate health and economic impacts of St. John's wort versus antidepressants. Outcomes were treatment costs, quality-adjusted life years (QALYs) and Net Monetary Benefits (NMB). Probabilistic analyses were conducted on key model parameters. RESULTS: The average NMB across 5000 simulations identified St. John's wort as the strategy with the highest net benefit. The total cost savings for SJW were $359.66 and $202.56 per individual for venlafaxine and sertraline respectively, with a gain of 0.08 to 0.12 QALYs over the 72 weeks of the model. LIMITATIONS: A lack of direct comparative clinical trial data comparing SJW to venlafaxine and limited data with sertraline as a comparator was a major limitation. CONCLUSIONS: In this model, St. John's wort was shown to be a cost-effective alternative to generic antidepressants. Patients are more likely to receive treatment for a duration consistent with professional guidelines for treatment of major depression due to reduced incidence of adverse effects, improving outcomes. This represents an important option in the treatment of Major Depressive Disorder.

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Available from: Daniela Solomon, Apr 22, 2014
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    • "The existence of (albeit limited) evidence supporting its clinical and cost-effectiveness (Foroushani et al., 2011; Gerhards et al., 2010; Kaltenthaler et al., 2006) has led to recommendations of CCBT as a treatment option for mild to moderate depression by the National Institute for Health and Clinical Excellence (NICE, 2010). Alternative therapies remain relatively underexplored from a health economic perspective (Solomon et al., 2013; Spinks and Hollingsworth, 2009). Although these may be purchased out of pocket, from a public healthcare perspective failure of rigorous evaluation may mean that cost-effective treatment options are not utilised. "
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