Effectiveness and Cost-Effectiveness of Antidepressants in Primary Care
2012
This article, published in PLoS One, presents a decision tree model to compare the effectiveness and cost-effectiveness of pharmacological first line treatment in primary care for patients with moderate to severe depression. The authors compare 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine) over a one-year time horizon. A meta-analysis was conducted to obtains the remission rates from randomized controlled trials and cost and quality-adjusted life years (QALYs) were obtained from published data. The analysis was conducted from the societal perspective.
The results show that escitalopram is the most favorable pharmacological treatment in terms of remission with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3,732 compared with venlafaxine.
Based on these findings the authors conclude that escitalopram is the preferred treatment option in a primary care setting in terms of both effectiveness and cost-effectiveness with the highest probability of remission.
Effectiveness and Cost-Effectiveness of Antidepressants in Primary Care
Source:
Ramsberg J, Asseburg C, Henriksson M. Effectiveness and Cost-Effectiveness of Antidepressants in Primary Care: A Multiple Treatment Comparison Meta-Analysis and Cost-Effectiveness Model. PLOS One 2012; 7 (8): e42003. https://doi.org/10.1371/journal.pone.0042003