Evidence map›Paper›PMID 41333541›Full record

ArticleThe Lancet regional health. Europe2026

Cost-effectiveness of pramipexole augmentation for acute phase and maintenance therapy of treatment-resistant depression compared to placebo augmentation: economic evaluation of the PAX-D randomised controlled trial.

Agata Łaszewska, Timea Helter, Ashley Baldwin, Anthony J Cleare, Philip J Cowen, Jonathan Evans, Quentin J M Huys, Micheal Kurkar, Alexander C Lewis, Neil Nixon and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Agata ŁaszewskaCenter for Public Health, Department of Health Economics, Medical University of Vienna, Vienna, Austria.
Timea HelterCenter for Public Health, Department of Health Economics, Medical University of Vienna, Vienna, Austria.
Ashley BaldwinMersey Care NHS Foundation Trust, UK.
Anthony J CleareInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Bristol, UK.
Philip J CowenDepartment of Psychiatry, University of Oxford, Oxford, UK.
Jonathan EvansBristol Medical School, Bristol Population Health Science Institute, University of Bristol, Bristol, UK.
Quentin J M HuysApplied Computational Psychiatry Lab, Division of Psychiatry and Queen Square Institute of Neurology, University College London, UK.
Micheal KurkarPennine Care NHS Foundation Trust, UK.
Alexander C LewisDepartment of Psychiatry, University of Oxford, Oxford, UK.
Neil NixonMental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, UK.
Abhinav RastogiMidlands Partnership NHS Foundation Trust, UK.
Stuart WatsonTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
John R GeddesDepartment of Psychiatry, University of Oxford, Oxford, UK.
Michael BrowningDepartment of Psychiatry, University of Oxford, Oxford, UK.
Judit SimonCenter for Public Health, Department of Health Economics, Medical University of Vienna, Vienna, Austria.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Pramipexole augmentation of antidepressant treatment for treatment-resistant depression (TRD) has been shown to improve symptom burden over 12 weeks but with some adverse effects compared to placebo augmentation. We aimed to evaluate the cost-effectiveness of pramipexole augmentation for TRD. Methods: We conducted an economic evaluation as part of the PAX-D trial over 12 and 48 weeks. Two costing perspectives, National Health Service and Personal Social Services (NHS + PSS) and societal, were adopted. The primary outcome was quality-adjusted life year (QALY) based on the EQ-5D-5L. Secondary outcomes included year of full capability (YFC) based on the ICECAP-A, and capability-weighted life year (CWLY) based on the OxCAP-MH. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes and cost-effectiveness acceptability curves were reported alongside sensitivity analyses. The trial was registered with ISCTRN (ISRCTN84666271) and EudraCT (2019-001023-13) and is complete. Findings: From the NHS + PSS perspective, mean incremental cost of pramipexole was £60 (95% CI: -£55, £176) over 12 weeks and £811 (95% CI: £110, £1513) over 48 weeks. The difference in QALY gained was 0.012 (95% CI: 0.003, 0.021) over 12 weeks and 0.090 (95% CI: 0.036, 0.144) over 48 weeks, equivalent to 4 (95% CI: 1, 8) and 33 (95% CI: 13, 52) days in perfect health. The ICER was £5069/QALY (95% CI: -£3642, £35,608) over 12 weeks and £9007/QALY (95% CI: £2,219, £27,258) over 48 weeks, representing over 90% probability of cost-effectiveness at £20,000/QALY threshold. From the societal perspective, pramipexole was on average cost saving and more effective over 48 weeks. Alternative analyses provided consistent conclusions. Interpretation: Pramipexole augmentation for TRD has demonstrated both clinical and cost-effectiveness. Further trials, directly comparing pramipexole to other augmentation strategies, will be useful in determining the position of this repurposed medication in the treatment pathway of depression. Funding: National Institute for Health and Care Research, Efficacy and Mechanism Evaluation Programme.

Indexed as

CapabilitiesCost-effectiveness analysisHealth economicsPramipexoleQuality of lifeTreatment-resistant depression

Identifiers

PMID41333541
PMCPMC12666355

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.