Cost-effectiveness Of Antidepressants Research Articles

Cost per successfully treated patient for vortioxetine versus duloxetine in adults with major depressive disorder: an analysis of the complete symptoms of depression and functional outcome

Objective: To determine the cost-effectiveness of vortioxetine vs duloxetine in adults with moderate-to-severe major depressive disorder (MDD) in Norway using a definition of a successfully treated patient (STP) that incorporates improvement in both mood symptoms and functional capacity.Methods: Using the population of patients who completed the 8-week CONNECT study, the cost-effectiveness of vortioxetine (n = 168) (10–20 mg/day) vs duloxetine (n = 176) (60 mg/day) was investigated for the treatment of adults in Norway with moderate-to-severe MDD and self-reported cognitive dysfunction over an 8-week treatment period. Cost-effectiveness was assessed in terms of cost per STP, defined as improvement in mood symptoms (≥50% decrease from baseline in Montgomery-Åsberg Depression Rating Scale total score) and change in UCSD [University of California San Diego] performance-based skills assessment [UPSA] score of ≥7. The base case analysis utilized pharmacy retail price (apotek utsalgspris (AUP)) for branded vortioxetine (Brintellix) and branded duloxetine (Cymbalta).Results: After 8 weeks of antidepressant therapy, there were more STPs with vortioxetine than with duloxetine (27.4% vs 22.5%, respectively). The mean number needed to treat for each STP was 3.6 for vortioxetine and 4.4 for duloxetine, resulting in a lower mean cost per STP for vortioxetine (NOK [Norwegian Kroner] 3264) than for duloxetine (NOK 3310) and an incremental cost per STP of NOK 3051. The use of a more challenging change in the UPSA score from baseline (≥9) resulted in a mean cost per STP of NOK 3822 for vortioxetine compared with NOK 3983 for duloxetine and an incremental cost per STP of NOK 3181.Conclusions: Vortioxetine may be a cost-effective alternative to duloxetine, owing to its superior ability to improve functional capacity. The dual-response STP concept introduced here represents a more comprehensive analysis of the cost-effectiveness of antidepressants.

Effectiveness and Cost-Effectiveness of Antidepressants in Primary Care: A Multiple Treatment Comparison Meta-Analysis and Cost-Effectiveness Model

ObjectiveTo determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression.DesignA multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine). The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year.Data SourcesMeta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources.ResultsThe most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine.ConclusionOf the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

Protocol for the THREAD (THREshold for AntiDepressants) study: a randomised controlled trial to determine the clinical and cost-effectiveness of antidepressants plus supportive care, versus supportive care alone, for mild to moderate depression in UK general practice.

BackgroundDepression guidelines in the UK recommended a policy of watchful waiting for mild depression due to a lack of evidence for the effectiveness of antidepressant treatment for mild cases. However there has been relatively little research carried out in primary care to help establish the severity threshold at which antidepressant treatment is effective and cost-effective.Methods/DesignThe THREAD (THREshold for AntiDepressants) study is a multi-centre randomised controlled trial designed to determine the clinical and cost effectiveness of a selective serotonin reuptake inhibitor (SSRI) plus general practitioner (GP) supportive care, versus supportive care alone, for mild to moderate depression in primary care. The aim is to recruit 300 patients from three centres (Southampton, London and Liverpool). Depressive symptoms will be assessed at baseline, 12 weeks and 26 weeks, using the 17-item Hamilton Depression Rating Scale (HDRS). Two severity sub-groups of patients will be recruited, with HDRS scores of 12–15, and 16–19. Possible predictors of response will be explored including life events and difficulties and alcohol consumption. Analysis of covariance, controlling for baseline value, severity group and centre will be used to estimate the overall treatment effectiveness (difference in HDRS score) at final follow up. The primary analysis will be by 'intention to treat' using double sided tests. The interaction between severity sub-group and treatment will be tested, and if appropriate, effects within separate severity sub-groups estimated. The economic analysis will compare the two treatment groups in terms of mean costs and cost-effectiveness.DiscussionThe results of this study will give GPs important information to help them determine the severity of depression at which antidepressant treatment is likely to be cost-effective.

Comparison of the effectiveness of reboxetine versus fluoxetine in patients with atypical depression: A single-blind, randomized clinical trial

The atypical subtype of depression appears to be well validated and common, and it is unique among Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) in that it includes a personality trait, rejection sensitivity, as a criterion. Drug selection remains a challenge for the clinician who treats patients with this subtype of depression. Noradrenergic antidepressants have been thought to have prominent effects in improving such symptoms as loss of motivation, drive, and energy, which are among the core symptoms of patients with atypical depression. Thus it can be speculated that noradrenergic antidepressants might be superior to serotonergic antidepressants in reducing symptoms of atypical depression. This is the first study to compare the efficacy of fluoxetine, a selective reuptake inhibitor of serotonin, and reboxetine, a selective reuptake inhibitor of norepinephrine, in the treatment of patients with atypical depression. A total of 43 patients with atypical depression according to DSM-IV were randomly assigned to receive fluoxetine or reboxetine over an 8-wk clinical trial. Patients with a Structured Clinical Interview for DSM-IV diagnosis of personality disorder accounted for 54% of those with atypical depression in this sample. Patients with personality disorders were typically young and were unable to maintain a marriage. Adverse effects such as dry mouth, sweating, headache, and urinary retention were more prominent in the reboxetine group than among those given fluoxetine. Although a greater number of patients treated with reboxetine dropped out of treatment, the pattern of response was very similar for both drugs, and both were effective in reducing symptoms of depression. The presence of a personality disorder in patients with atypical depression did not affect the response to either of the antidepressants. These findings might suggest that drugs with norepinephrine or a 5-hydroxytryptamine mechanism of action might act through a common pathway, resulting in a similar response in terms of core symptoms of depression. If tolerability, efficacy, and cost-effectiveness of antidepressants are considered, the best antidepressant is the one that can be used by the patient, whether or not a personality disorder accompanies atypical depression.

Developing models for assessing the cost-effectiveness of antidepressants in primary care

Developing models for assessing the cost-effectiveness of antidepressants in primary care

7-3 - Cost effectiveness of antidepressants: An European perspective

7-3 - Cost effectiveness of antidepressants: An European perspective

7-4 - Cost-effectiveness of antidepressants in the USA

7-4 - Cost-effectiveness of antidepressants in the USA