Cost Analysis of Paroxetine versus Imipramine in Major Depression
A simulation decision analytical model was used to compare the annual direct medical costs of treating patients with major depression using the selective serotonin reuptake inhibitor (SSRI) paroxetine or the tricyclic antidepressant (TeA) imipramine. Medical treatment patterns were determined from focus groups of general and family practitioners and psychiatrists in Boston, Dallas and Chicago, US. Direct medical costs included the wholesale drug acquisition costs (based on a 6-month course of drug therapy), psychiatrist and/or general practitioner visits, hospital outpatient visits, hospitalisation and electroconvulsive therapy. Acute phase treatment failure rates were derived from an intention-to-treat analysis of a previously published trial of paroxetine. imipramine and placebo in patients with major depression. Maintenance phase relapse rates were obtained from a 12-month trial of paroxetine, supplemented from the medical literature. The relapse rates for the final 6 months of the year were obtained from medical literature and expert opinion. Direct medical costs were estimated from a health insurance claims database.
The estimated total direct medical cost per patient was slightly lower using paroxeline ($US2348) than generic imipramine ($US2448) as first-line therapy. This result was sensitive to short term dropout rates but robust to changes in other major parameters, including hospitalisation costs and relapse rates. The financial benefit of paroxetine. despite its 15-fold higher acquisition cost compared with imipramine. is attributable to a higher rate of completion of the initial course of therapy and consequent reduced hospitalisation rates.
KeywordsMajor Depression Relapse Rate Paroxetine Imipramine Acquisition Cost
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- 2.National Institute of Mental Health/National Institutes of Health Consensus Development Conference. Am J Psychiatr 1985; 142: 469–76Google Scholar
- 4.Rice DP. Conceptual and estimation issues related to cost of illness studies. 2nd International Workshop on Costs and Assessment in Psychiatry: The Costs of Affective Disorders; 1992 Oct 26-28: Venice (Italy)Google Scholar
- 5.Greenberg PE, Stiglin LE, Finkelstein SN. The economic burden of depression in 1990. J Clin Psychiatr 1993; 54: 405–18Google Scholar
- 6.Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987Google Scholar
- 9.McCombs JS, Nichol MB, Stimmel GL, et al. The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a Medicaid population. J Clin Psychiatr 1990: 51(6 Suppl): 60–9Google Scholar
- 10.Haynes RB, Taylor DN, Sackett DL, editors. Compliance in healthcare. Baltimore: Johns Hopkins University Press, 1979Google Scholar
- 11.Sackett DL, Haynes RB, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. Boston: Little, Brown & Company, 1985Google Scholar
- 13.Dunbar GC, Stoker MJ. Overview of world-wide data base for safely and efficacy of paroxetine [abstract]. 5th World Congress of Biopsychiatry; 1991: FlorenceGoogle Scholar
- 15.Tollefson GD. Antidepressant treatment and side effect considerations. J Clin Psychiatr 1991; 52Suppl 2: S4–13Google Scholar
- 16.Stewart A. Antidepressant pharmacotherapy: cost comparison of SSRIs and TCAs. Br J Med Econ 1994; 7: 67–79Google Scholar
- 18.Kupfer DJ. Long-term treatment of depression. J Clin Psychiatr 1991; 52(5): 28–34Google Scholar
- 19.ICD-9-CM (International Classification of Diseases, 9th rev. ed., clinical modification). 4th ed. US Department of Health and Human Services: 1991 Oct. Publication No (PHS) 81–1260Google Scholar
- 20.DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. ed.) Washington, DC: American Psychiatric Association, 1987Google Scholar