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Value of monitoring negative emotional bias in primary care in England for personalised antidepressant treatment: a modelling study
  1. Judit Simon1,2,
  2. Catherine J Harmer2,3,
  3. Jonathan Kingslake4,
  4. Gerard R Dawson4,
  5. Colin T Dourish4,
  6. Guy M Goodwin2,3
  1. 1 Department of Health Economics, Center for Public Health, Medical University of Vienna, Wien, Austria
  2. 2 Department of Psychiatry, University of Oxford, Oxford, UK
  3. 3 Oxford Health NHS Foundation Trust, Oxford, UK
  4. 4 P1vital Products Ltd, Wallingford, UK
  1. Correspondence to Professor Judit Simon, Department of Health Economics, Center for Public Health, Medical University of Vienna, Wien 1090, Austria; judit.simon{at}


Background Depressed patients often focus on negative life events. Effective antidepressant therapy reverses this negative emotional bias (NEB) within 1 week. Clinical therapeutic effect usually requires 4–6 weeks. The value of implementing NEB monitoring for the personalisation of antidepressant therapy is unknown.

Objective To estimate the likely outcome and cost consequences of adopting the P1vital Oxford Emotional Test Battery (ETB) for this purpose in routine primary care in England.

Methods A hybrid decision analytic model (decision tree plus Markov model) was developed to estimate the cost-effectiveness of ETB monitoring versus no ETB over 52 weeks using quality-adjusted life years (QALYs). Differences in depression severity, episode type and analytical perspectives were considered. Input data were derived from relevant guidelines, literature, national databases, expert opinion and the developers for the year 2013. Multiple sensitivity analyses addressed uncertainty.

Findings The mean number of ETB tests is 2.162 per newly diagnosed patient and 2.166 per patient with recurrent depression. The incremental cost-effectiveness of ETB versus ‘no ETB’ is £4355/QALY from the healthcare perspective. From the broader societal perspective, ETB is more effective and cost saving.

Conclusions Monitoring negative emotional bias in primary care in England for personalised antidepressant treatment using ETB seems as an effective and cost-effective option under all considered scenarios (including worst case). Its main economic value seems to lie in reduced productivity loss as opposed to healthcare savings.

Clinical implications The test supports accelerated application of evidence-based depression care. Further optimisation and implementation in the ongoing European PReDicT trial is ongoing.

  • depression & mood disorders
  • adult psychiatry
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  • Contributors JS designed and developed the modelling study, carried out the data collection from public sources, analysed the data and wrote the first draft. CJH and GMG provided expert input. JK, GRD and CTD carried out the GP survey and provided the experimental data. All authors contributed to the conceptualisation of the study, validated the model, commented on the draft paper and approved the final version.

  • Funding This work was funded by Innovate UK (previously Technology Strategy Board) SBRI Stratified medicine: Determining patient response competition (project no. 20328-149139). The PReDicT trial is sponsored by P1vital and co-funded by the Horizon 2020 SME programme of the European Union (ref 696802).

  • Competing interests GRD, JK and CTD own shares in P1vital Products Ltd. JK is an employee of P1vital Products Ltd. GRD, CTD, GMG and CJH own shares in P1vital Ltd. GRD and CTD are employees of P1vital Ltd.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All input data relevant to the study are included in the article or uploaded as online supplementary information.

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