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Cost-effectiveness of antidepressant treatment reassessed

Published online by Cambridge University Press:  03 January 2018

Scott W. Woods  and
John A. Rizzo
Scott W. Woods*
Affiliation:
Department of Psychiatry, Yale University School of Medicine and the Treatment Research Program, Connecticut Mental Health Center, New Haven
John A. Rizzo
Affiliation:
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
*
Scott W. Woods, MD, Yale University School of Medicine, 34 Park Street, Room B-38, New Haven, CT 06519, USA
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Abstract

Background

A recent simulation concluded that the serotonin-specific reuptake inhibitor (SSRI) paroxetine was more cost-effective than the tricyclic antidepressant (TCA) imipramine, despite substantially higher medication acquisition costs.

Method

We replicated the previous model and revised key assumptions which drove the results. The revised model was subjected to sensitivity analysis.

Results

Most scenarios in the revised model showed that the TCA is equally or more cost-effective than the SSRI. Model revision producing these results were changes in assumptions about switched treatment success rates, treatment length and initial treatment success. The revised model appears sensitive to drug acquisition and delivery costs and costs of treatment failure.

Conclusions

Based on the model, a policy of using TCAs as first-choice antidepressant treatment, with SSRIs reserved for those patients not doing well initially, appears more cost-effective than the reverse sequence. Given limitations in current knowledge about key parameters to include in a simulation model, large prospective random-assignment cost-effectiveness studies are needed.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 3 , March 1997 , pp. 257 - 263
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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References

Agency for Health Care Policy and Reaserch (1993) Depression in Primary Care. vol. 2. Treatment of Major Depression. Rockville, MD: US Department of Health and Human Services.Google Scholar
Anderson, I. M. & Tomenson, B. M. (1995) Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: A meta-analysis. British Medical Journal. 310, 1433–1438.CrossRefGoogle ScholarPubMed
Dunbar, G. C., Cohn, J. B., Fabre, L. F., et al (1991) A comparison of paroxetine, imipramine and placebo in depressed out-patients. British Journal of Psychiatry. 159, 394–398.CrossRefGoogle ScholarPubMed
Dunner, D. L. & Dunbar, G. C. (1992) Optimal dose reginrien for paroxetine. Journal of Clinical Psychiatry. 53, 21–26.Google ScholarPubMed
Freemantle, N., House, A., Song, F., et al (1994) Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide. British Medical Journal. 309, 249–253.CrossRefGoogle Scholar
Freemantle, N., House, A., Song, F., Mason, J., et al (1995) Economics of treatment of depression (letter). British Journal of Psychiatry. 166, 397–399.CrossRefGoogle Scholar
Jönsson, B. & Bebbington, P. (1993) Economic studies of the treatment of depressive illness. In Health Economics of Depression (eds Jönsson, B. & Rosenbaum, J.), pp. 35–48. Chichester: Wiley.Google Scholar
Jönsson, B. & Bebbington, P. (1994) What price depression? The cost of depression and the cost-effectiveness soft pharmacological treatnnent. British Journal of Psychiatry. 164, 665–673.CrossRefGoogle Scholar
Jönsson, B. & Bebbington, P. (1995a) Reply to Freemantle et al (letter). British Journal of Psychiatry. 166, 398–399.CrossRefGoogle Scholar
Jönsson, B. & Bebbington, P. (1995b) Reply to Owens (letter). British Journal of Psychiatry. 167, 112.CrossRefGoogle Scholar
Katon, W., Korff, M., Lin, E., et al (1995) Collaborative management to achieve treatment guidelines. Impact on depression in primary care. Journal of the American Medical Association. 273, 1026–1031.CrossRefGoogle ScholarPubMed
Montgomery, S. A., Henry, J., McDonald, G., et al (1994) Selective serotonin reuptake inhibitors: Meta-analysis of discontinuation rates. International clinical Psychopharmacohgy, 9, 47–53 (erratum: 9. 296).CrossRefGoogle ScholarPubMed
Nielsen, Q. A., Morsing, I., Petersen, J. S., et al (1991) Paroxetine and imipramine treatment of depressive patients in a controlled multicentre study with plasma amino acid measurements. Acto Psychiatrica Scandinavica, 84, 233–241.CrossRefGoogle Scholar
Ohrberg, S., Christiansen, P. E., Severin, B., et al (1992) Paroxetine and imipramine in the treatment of depressive patients in psychiatric practice. Acta Psychiatrica Scandinavica. 86.437–444.CrossRefGoogle ScholarPubMed
Owens, D. W. (1995) Economics of treatment of depression. British Journal of Psychiatry, 167, 112.CrossRefGoogle ScholarPubMed
Paylcel, E. S. & Priest, R. G. (1992) Recognition and management of depression in general practice: Consensus sUtement. British Medical Journal. 395, 1198–1202.Google Scholar
Simon, G. E., & Vonlcorff, M., Helligenstein, J. H. et al (1996) Initial antidepressant choice in primary care. Effectiveness and cost of fluoxetine vs tricyclic antidepressants. Journal of the American Medical Association. 275, 1897–1902.CrossRefGoogle ScholarPubMed
Thompson, C. (1995) Economics of treatment of depression. British Journal of Psychiatry, 167, 112.CrossRefGoogle ScholarPubMed
Wells, K. B., Burnam, M. A. & Camp, P. (1995) Severity of depression in prepaid and fee-for-service general medical and mental health specialty practices. Medical Care. 33, 350–364.CrossRefGoogle ScholarPubMed
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