Cost-effectiveness of family psychoeducation to prevent relapse in major depression: Results from a randomized controlled trial
Open accessAbstract
Background: Family psychoeducation is a relatively simple and straightforward intervention whose prophylactic effectiveness and cost-effectiveness is well-established for schizophrenia. We have recently demonstrated its effectiveness for unipolar depression, but its cost-effectiveness has never been examined. We hereby report a cost-effectiveness analysis alongside a randomized controlled trial in order to assess its cost-effectiveness for preventing relapse/recurrence in depression. Methods: Fifty-seven patients diagnosed with major depression and undergoing its maintenance treatment, and their primary family members were randomized to treatment as usual (TAU) only or to TAU plus family psychoeducation, which consisted of four 2-hour multiple-family sessions consisting of didactic lectures about depression (30 minutes) and group discussion and problem solving (60–90 minutes). The economic analyses were undertaken from the perspective of the National Health Insurance (NHI), assuming the most reasonable price of US$50 per psychoeducation session per patient. The main outcome measures included relapse-free days and direct costs to the NHI. Results: The intervention group enjoyed 272 (SD: 7.1) relapse-free days, while the control group spent 214 (SD: 90.8) relapse-free days (Cox proportional hazard ratio = 0.17, 95%CI: 0.04 to 0.75, p = 0.002). Cost-effectiveness acceptability curves suggested that the family psychoeducation has 90% or more chances of being cost-effective if the decision-maker is prepared to pay US$20 for one additional relapse-free day. This cost-effectiveness finding was robust when the price for family psychoeducation ranged between 50% to 150% of the baseline scenario in sensitivity analyses. If a relapse-free day is considered to be worth $30 or more, all the pricing scenarios have a close to 100% probability of being cost-effective. Conclusion: Family psychoeducation is effective in the relapse prevention of depression and is highly likely to be cost-effective if a relapse-free day is valued as US$20 or more. Trial registration: UMIN-CTR (UMIN000005555)
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Family psychoeducation appeared to be useful long-term in two studies reported from Japan.
“Family psychoeducation appeared to be useful long-term in two studies reported from Japan (Shimazu et al., 2011; Shimodera et al., 2012).”
From Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials (2016) · cites this paper as Shimodera et al., 2012
The Results > Clinical outcomes section reports fewer relapses and more relapse-free days with family psychoeducation during nine months of follow-up in this Japanese trial. But the Discussion explicitly says whether its preventive effect lasts beyond nine months is unknown, so the source does not establish long-term usefulness. This verdict addresses Shimodera et al. only, not the other study cited in the sentence; our copy provides no page numbers. (LLM, conf=0.87)
Experimental — accuracy not yet measuredFamily psychoeducation continued for up to 10 months was cost-effective.
“Among these, notably, family psychoeducation continued for up to 10 months was examined in two Japanese studies and found to be clinically effective and cost-effective in reducing recurrence risks in major depressive disorder patients (Shimazu et al., 2011; Shimodera et al., 2012).”
From Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials (2016) · cites this paper as Shimodera et al., 2012
The Discussion and Conclusion report that family psychoeducation was likely to be cost-effective in preventing relapse in major depression. But the Methods > Procedure describes four sessions held every two weeks, followed by nine months of observation—not psychoeducation continued for up to 10 months. The Discussion also says whether its preventive effect lasts beyond nine months is unknown. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFamily psychoeducation continued for up to 10 months reduced recurrence risks in patients with major depressive disorder (clinically effective).
“Among these, notably, family psychoeducation continued for up to 10 months was examined in two Japanese studies and found to be clinically effective and cost-effective in reducing recurrence risks in major depressive disorder patients (Shimazu et al., 2011; Shimodera et al., 2012).”
From Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials (2016) · cites this paper as Shimodera et al., 2012
The Results > Clinical outcomes report fewer relapses with family psychoeducation than with treatment as usual over nine months (2 versus 15). But Methods > Procedure describes four sessions held every two weeks, not psychoeducation continued for up to 10 months; nine months was the follow-up period. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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- Authors
- Shimodera, S., Furukawa, T. A., Mino, Y., Shimazu, K., Nishida, A., & Inoue, S.
- Affiliations
- Kochi Medical School Hospital (JP)
- Kyoto University (JP)
- Tokyo Metropolitan Institute of Medical Science (JP)
- Corresponding author
- Furukawa, Toshi A
- Venue
- BMC Psychiatry
- Published
- 2012-05-14
- Volume
- 12
- Issue
- 1
- Pages
- 40-40
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3473266
- OpenAlex
- W2028823454
- Cited by
- 43
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 7 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 8 · 2014: 5 · 2013: 2
- FWCI
- 11.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Ministry of Health, Labour and Welfare
- Japan Society for the Promotion of Science (22590472, 22591288)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- family psychoeducation, major depressive disorder, relapse prevention, cost-effectiveness, maintenance therapy, family involvement in treatment, health insurance costs, willingness to pay
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Depressive Disorder, Major, Major Depressive Disorder, Family Therapy, Female, Humans, Male, Middle Aged, Patient Education as Topic, Problem Solving, Treatment Outcome, Secondary Prevention
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