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Cost Effectiveness of Venlafaxine Compared with Generic Fluoxetine or Generic Amitriptyline in Major Depressive Disorder in the UK

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Abstract

Objective: To estimate the cost effectiveness of venlafaxine compared with generic fluoxetine and generic amitriptyline used in major depressive disorder in primary care in the UK.

Methods: A decision-tree model for the treatment of major depressive disorder was constructed using a Delphi panel. The tree was populated with clinical success rates from a pooled analysis of fluoxetine compared with venlafaxine and a clinical trial of amitriptyline compared with venlafaxine using remission as the key endpoint. Where there was insufficient data from clinical trials, the Delphi panel was used. Costs within the tree were taken from contemporary UK sources. Six-monthly costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were then estimated.

Results: Treatment costs for 6 months were £1530 for venlafaxine, £1539 for fluoxetine and £1558 for amitriptyline (year of costing 2006). Cost effectiveness as assessed by incremental cost per QALY ratio at 8 weeks was £20 600 for venlafaxine compared with fluoxetine, with fluoxetine dominating (being less costly and more effective than) amitriptyline. To test the robustness of the model a Rank Order Stability Assessment was performed that showed that even if fluoxetine and/or amitriptyline were given away free, a scenario starting with venlafaxine would still be the least costly treatment over a 6-month period.

Conclusions: In this model, venlafaxine was shown to be a cost-effective alternative to generic fluoxetine and amitriptyline when used as a first-line therapy. Thus, cost of therapy should not be a barrier to use of venlafaxine as a first-line option in treating major depressive disorder in primary care in the UK.

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References

  1. Jenkins R, Lewis G, Bebbington P, et al. The National Psychiatric Morbidity Surveys of Great Britain: initial findings from the household survey. Psychol Med 1997; 27: 775–89

    Article  PubMed  CAS  Google Scholar 

  2. Lepine J–P, Gastpar M, Mendlewicz J, et al. Depression in the community: the first pan European study —EPRES (Depression Research in European Society). Int Clin Psychopharmacol 1997; 12: 19–29

    Article  PubMed  CAS  Google Scholar 

  3. Thomas CM, Morris S. Cost of depression amongst adults in England in 2000. Br J Psychiatry 2003; 183: 311–9

    Article  Google Scholar 

  4. Depression (amended). Management of depression in primary and secondary care. NICE Clinical Guideline 23 (amended): April 2007 [online]. Available from URL: http://http://www.nice.org.uk [Accessed 2009 Feb 1]

  5. Anderson IM, Nutt DJ, Deakin JFW, et al. Evidence-based guidelines for treating depressive disorders with anti-depressants: a revision of the 1993 British Association for Psychopharmacology Guidelines. J Psychopharmacol 2000; 14(1): 3–20

    Article  PubMed  CAS  Google Scholar 

  6. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006; 163: 28–40

    Article  PubMed  Google Scholar 

  7. De Nayer A, Geerts S, Ruelens L, et al. Venlafaxine compared with fluoxetine in outpatients with depression and concomitant anxiety. Int J Neuropsychopharmacol 2002; 5: 115–20

    PubMed  Google Scholar 

  8. Smith D, Dempster C, Glanville J, et al. Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: a meta-analysis. Br J Psychiatry 2002; 180: 396–404

    Article  PubMed  Google Scholar 

  9. Lenox-Smith A, Conway P, Knight C, et al. Cost effectiveness of representatives of three classes of antidepressants used in major depression in the UK. PharmacoEconomics 2004; 22(5): 311–9

    Article  PubMed  Google Scholar 

  10. Trivedi MH, Wan GJ, Mallick R, et al. Cost and effectiveness of venlafaxine extended-release and selective serotonin reuptake inhibitors in the acute phase of outpatient treatment for major depressive disorder. J Clin Psychopharmacol 2004; 24: 497–506

    Article  PubMed  CAS  Google Scholar 

  11. Lave JR, Frank RG, Schulberg HC, et al. Cost-effectiveness of treatments for depression in primary care practice. Arch Gen Psychiatry 1998; 55(7): 645–51

    Article  PubMed  CAS  Google Scholar 

  12. Mallick R, Chen J, Entsuah AR, et al. Depression-free days as a summary measure of the temporal pattern of response and remission in the treatment of major depression: a comparison of venlafaxine, selective serotonin reuptake inhibitors and placebo. J Clin Psychiatry 2003; 64(3): 321–30

    Article  PubMed  CAS  Google Scholar 

  13. NHS reference costs 2005–06, Department of Health, Accessed by: http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_062884

  14. Curtis L, Netten A. Unit costs of health & social care 2005. Canterbury. Personal Social Services Research unit

  15. Montgomery SA, Brown RE, Clark M. Economic analysis of treating depression with nefazodone v. imipramine. Br J of Psychiatry 1996; 168: 768–71

    Article  CAS  Google Scholar 

  16. NICE Guidance Electroconvulsive therapy (ECT) (No. 59) 2003 [online]. Available from URL: http://http://www.nice.org.uk/nicemedia/pdf/59ectfullguidance.pdf [Accessed 2009 Feb 1]

  17. Netten A, Curtis L. Unit costs of health & social care 2003. Canterbury. Personal Social Services Research unit

  18. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed., revised: DSM-III-R. Washington, DC: American Psychiatric Association, 1987

  19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., revised: DSM-IV-R. Washington, DC: American Psychiatric Association, 2000

  20. Nemeroff C, Cantillon M. A comparison of venlafaxine versus fluoxetine or placebo in depressed outpatients. Poster presented at CINP, Brussels, 2000

  21. Schatzberg A, Cantillon M. Antidepressant early response and remission with venlafaxine or fluoxetine in depressed geriatric outpatients. Poster presented at CINP, Brussels, 2000

  22. Rudolph R, Feiger A. A double-blind, randomized, placebo-controlled trial of once-daily venlafaxine extended release (XR) and fluoxetine for the treatment of depression. J Affect Disord 1999; 56: 171–81

    Article  PubMed  CAS  Google Scholar 

  23. Dierick M, Ravizza L, Realini R, et al. A double-blind comparison of venlafaxine and fluoxetine for treatment of major depression in outpatients. Prog Neuro-Psychopharmacol Biol Psychiat 1996; 20: 57–71

    Article  CAS  Google Scholar 

  24. Silverstone PH, Entsuah R, Hackett D, et al. Once-daily venlafaxine extended-release (XR) compared with fluoxetine and outpatients with depression and anxiety. J Clin Psychiatry 1999; 60: 22–8

    Article  PubMed  CAS  Google Scholar 

  25. Rudolph R. Early onset of antidepressant activity of venlafaxine compared with placebo and fluoxetine in outpatients in a double-blind study. Hamburg: poster presented at World Congress of Psychiatry; 1999

  26. Kornaat H. Randomised, double-blind comparison of venlafaxine and fluoxetine for moderately depressed out-patients. Poster presented at CINP 1997

  27. Tylee A, Beaumont G, Bowden MW, et al. A double-blind, randomized, 12 week comparison study of the safety and efficacy of venlafaxine and fluoxetine in moderate to severe major depression in general practice. Prim Care Psychiatry 1997; 3: 51–58

    Google Scholar 

  28. Alves C, Cachola I, Brandao J, et al. Efficacy and tolerability of venlafaxine and fluoxetine in outpatients with major depression. Prim Care Psychiatry 1999; 5(2): 57–63

    Google Scholar 

  29. Costa e Silva J. Randomized, double-blind comparison of venlafaxine and fluoxetine in outpatients with major depression. J Clin Psychiatry 1998; 59: 352–7

    Article  PubMed  Google Scholar 

  30. Stevens I. Comparison of the efficacy and safety of venlafaxine and fluoxetine in GP patients with moderate to severe depression. Poster presented at World Congress of Biological Psychiatry 1997

  31. Stevens I. Comparison of the efficacy and safety of venlafaxine and fluoxetine in GP patients with moderate to severe depression. Poster presented at World Congress of Biological Psychiatry 1997 au31._Ian Anderson. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000; 58(1): 19–36

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was fully funded by Wyeth. Drs Lenox-Smith, Greenstreet and Burslem are employees of Wyeth. Dr Knight has no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Wyeth Pharmaceuticals, Huntercombe Lane South, Taplow, Slough, SL6 0PH, UK

    Alan Lenox-Smith, Liz Greenstreet & Kate Burslem

  2. Heron Evidence Development Ltd, Letchworth, UK

    Chris Knight

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  1. Alan Lenox-Smith
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  2. Liz Greenstreet
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  3. Kate Burslem
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  4. Chris Knight
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Lenox-Smith, A., Greenstreet, L., Burslem, K. et al. Cost Effectiveness of Venlafaxine Compared with Generic Fluoxetine or Generic Amitriptyline in Major Depressive Disorder in the UK. Clin. Drug Investig. 29, 173–184 (2009). https://doi.org/10.2165/00044011-200929030-00004

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