Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the tads randomized trial

Marisa Elena Domino, E. Michael Foster, Benedetto Vitiello, Christopher J. Kratochvil, Barbara J. Burns, Susan G. Silva, Mark A. Reinecke, John S. March

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


OBJECTIVE:: The cost-effectiveness of three active interventions for major depression in adolescents was compared after 36 weeks of treatment in the Treatment of Adolescents with Depression Study. METHOD:: Outpatients aged 12 to 18 years with a primary diagnosis of major depression participated in a randomized controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Three hundred twenty-seven participants randomized to 1 of 3 active treatment arms, fluoxetine alone (n = 109), cognitive-behavioral therapy (n = 111) alone, or their combination (n = 107), were evaluated for a 3-month acute treatment and a 6-month continuation/maintenance treatment period. Costs of services received for the 36 weeks were estimated and examined in relation to the number of depression-free days and quality-adjusted life-years. Cost-effectiveness acceptability curves were also generated. Sensitivity analyses were conducted to assess treatment differences on the quality-adjusted life-years and cost-effectiveness measures. RESULTS:: Cognitive-behavioral therapy was the most costly treatment component (mean $1,787 [in monotherapy] and $1,833 [in combination therapy], median $1,923 [for both]). Reflecting higher direct and indirect costs associated with psychiatric hospital use, the costs of services received outside Treatment of Adolescents with Depression Study in fluoxetine-treated patients (mean $5,382, median $2,341) were significantly higher than those in participants treated with cognitive-behavioral therapy (mean $3,102, median $1,373) or combination (mean $2,705, median $927). Accordingly, cost-effectiveness acceptability curves indicate that combination treatment is highly likely (>90%) to be more cost-effective than fluoxetine alone at 36 weeks. Cognitive-behavioral therapy is not likely to be more cost-effective than fluoxetine. CONCLUSIONS:: These findings support the use of combination treatment in adolescents with depression over monotherapy.

Original languageEnglish (US)
Pages (from-to)711-720
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number7
StatePublished - Jul 2009
Externally publishedYes


  • Antidepressants
  • Cognitive-behavioral therapy
  • Cost-effectiveness
  • Depression

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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