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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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