Abstract
Objective: To estimate the cost effectiveness of representatives of three different classes of antidepressants used in major depression in the UK NHS.
Design, patients and interventions: A decision-tree model for the treatment of major depression was constructed by interviewing UK GPs and psychiatrists (as part of a Delphi panel). An important part of the tree was that patients in primary care were treated until remission (pre-morbid state). Three classes of antidepressants (serotonin and noradrenaline reuptake inhibitors [SNRIs; venlafaxine], selective serotonin reuptake inhibitors [SSRIs; fluoxetine, paroxetine and fluvoxamine] and tricyclic antidepressants [TCAs; amitriptyline]) were compared by populating the tree with clinical success rates determined by a meta-analysis and a clinical trial. Where there were insufficient data from clinical trials a Delphi panel was used. Costs within the tree were taken from UK data sources. Six-monthly costs and cost effectiveness were then calculated.
Main outcome measures and results: Treatment costs for 6 months were £1285 for venlafaxine, £1348 for SSRIs and £1385 for amitriptyline. Cost effectiveness as measured by cost per symptom-free day was £21 for venlafaxine, £26 for SSRIs and £32 for TCAs (2001 values). Incremental cost-effectiveness analyses showed a treatment strategy of using venlafaxine and switching if necessary to an SSRI was dominant over all other strategies considered. Sensitivity testing demonstrated that the cost of an SSRI could be reduced to 4 pence daily and amitriptyline to zero before the expected 6-monthly cost of venlafaxine ceased to be the lowest.
Conclusion: The SNRI, venlafaxine, may be a cost-effective option compared with the SSRIs and TCAs when used as a first-line drug for depression in primary care in the UK. As this is a model, cost effectiveness can be suggested but not proven.
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References
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
Psychiatric morbidity among adults living in private households, 2000 [online]. http://www.statisties.gov.uk/downloads/theme-health/psychmorb.pdf [Accessed 2004 Jan 13]
Lepine J-P, Gastpar M, Mendlewicz J, et al. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clinical Psychopharmacol 1997; 12: 19–29
IMS figures from British Pharmaceutical Index: MAT 2001 (database). London: IMS, 2001
Freeman H, Arikian S, Lenox-Smith A. Pharmacoeconomic analysis of antidepressants for major depressive disorder in the United Kingdom. Pharmacoeconomics 2000 Aug; 18 (2): 143–8
Rush AJ, Trivedi M. Treating depression to remission. Psychiatric Annals 1995; 25: 704–9
Paykel ES, Raman R, Cooper Z, et al. Residual symptoms after partial remission: an important outcome in depression. Psychol Med 1995; 25: 1171–80
Thase ME, Simons AD, McGeary J, et al. Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment. Am J Psychiatry 1992; 149: 1046–52
Thase ME, Entsuah AR, Rudolph RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001; 178 (3): 234–41
Beasley Jr CM, Sayler ME, Potvin III, et al. Fluoxetine versus amitriptyline in the treatment of major depression: a multicenter trial. Int Clin Psychopharmacol 1993; 8: 143–9
Einarson TR, Arikian SR, Casciano J, et al. Comparison of extended-release venlafaxine, selective serotonin reuptake inhibitors, and tricyclic antidepressants in the treatment of de pression: a meta-analysis of randomized controlled trials. Clin Ther 1999; 21 (2): 296–308
Office of National Statistics. Consumer price indices, July 2002 [online]. Available from URL: http://www.statisties.gov.uk/pdfdir/cpi0802.pdf [Accessed 2003 Jan 13]
Kind P, Sorensen J. The costs of depression. Int Clin Psychopharmacol 1993; 7 (3–4): 191–5
Din-link data. Woking, Surrey: CompuFile Ltd, MAT, 2002 Jun
Anderson I. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Dis; 58 (2000) 19–36
Lenox-Smith AJ, Schaeffer P, Reynolds A, et al. A double-blind trial of venlafaxine XR vs citalopram in patients with treatment-resistant depression. Poster presented at British Association for Psychopharmacology; 2001 Jul 21–24; Harrogate
Mehtonen O-P, editor. Randomised, double-blind comparison of venlafaxine and sertraline in outpatients with major depressive disorder. J Clin Psychiatry 2000; 61: 95–100
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This study was fully funded by Wyeth. Alan Lenox-Smith and Pete Conway are full-time employees of Wyeth.
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Lenox-Smith, A., Conway, P. & Knight, C. Cost Effectiveness of Representatives of Three Classes of Antidepressants Used in Major Depression in the UK. PharmacoEconomics 22, 311–319 (2004). https://doi.org/10.2165/00019053-200422050-00005
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DOI: https://doi.org/10.2165/00019053-200422050-00005