Abstract
AimsThe Prevention of Recurrent Episodes of Depression with venlafaxine XR for Two Years trial has reported advantages with maintenance treatment for patients with recurrent depressive disorder. The aim of this study was to assess the cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder, based on a recent clinical trial.MethodsA Markov simulation model was constructed to assess the cost-utility of maintenance treatment for 2 years in recurrently depressed patients in Sweden. Risk of relapse and recurrence was based on a recent randomised clinical trial assessing the efficacy and tolerability of maintenance treatment with venlafaxine over 2 years. Costs and quality of life estimations were retrieved from a naturalistic longitudinal observational study conducted in Sweden. Health effects were quantified as quality-adjusted life-years (QALYs). Sensitivity analyses were conducted on key parameters employed in the model.ResultsIn the base-case analysis, the cost per QALY gained of venlafaxine compared with no treatment was estimated at $18,500 over 2 years. In a probabilistic sensitivity analysis, we found that maintenance treatment with venlafaxine is cost-effective with 90% probability at a willingness to pay per QALY of $67,000 or less. Our long-term analyses also indicate that even under conservative assumptions about future risks of recurrences, maintenance treatment is cost-effective.ConclusionThe present study indicates that maintenance treatment for 2 years with venlafaxine is cost-effective in patients with recurrent major depressive disorder.
Highlights
Depression is one of the most important public health problems in the industrialised world, and is associated with a substantial economic burden on society
The results indicate that maintenance treatment for 2 years in recurrent depression is costeffective
From the societal perspective treatment with venlafaxine came at incremental cost of $1020 over 2 years, but generated a gain in quality-adjusted life-years (QALYs) of 0.055
Summary
Depression is one of the most important public health problems in the industrialised world, and is associated with a substantial economic burden on society. In the USA, Greenberg et al [1] found a total cost of 83.1 billion USD for the year 2000, whereof 31% direct medical costs, 7% suicide-related mortality costs and 62% costs for lost productivity at work. The overall prevalence was estimated at 18.1 million cases, and the treated prevalence was estimated at 7.9 million patients, for the year 2000. In many patients depression may develop into a recurrent disease, and the risk of recurrences seems to increase with the number of previous episodes of depression [7]. It is an important treatment goal to prevent recurrences
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