RESUMO
PURPOSE: Life-review has been established as an evidence-based treatment of depression in later life. This study investigates the cost-effectiveness of life-review compared to care-as-usual. METHODS: An economic evaluation alongside a randomized controlled trial was carried out, comparing life-review (n=100) to care-as-usual (n=102). Individuals of 55 years and over, with moderate depressive symptomatology, were included. Treatment response was defined as a statistically reliable reduction of depressive symptoms on the Center for Epidemiologic Studies Depression scale. Total per-participant costs encompassed intervention costs, costs of receiving other treatments, participants' out-of-pocket expenses, and costs stemming from production losses, and were expressed in (2009) euros (). RESULTS: At 6-month follow-up, treatment response was 54.0% and 27.5% in the life-review and usual-care conditions, respectively. The difference in effectiveness was statistically significant at p=.001 (2-tailed). In the respective conditions the costs were 5550 and 3162, with the higher costs in the intervention arm of the trial. The incremental cost-effectiveness was 8675 (US$10,227) per improved participant. CONCLUSION: The findings suggest that offering life-review rather than care-as-usual almost doubles the likelihood of a favorable outcome. However, the better clinical outcomes are achieved at greater costs. The conclusion that life-review offers good value for money is sensitive to the willingness to pay for a favorable treatment response. It is recommended that life-review is delivered by a single therapist and in larger groups as this may improve the cost-effectiveness of this intervention.
