ARE SSRIS A COST-EFFECTIVE ALTERNATIVE TO TRICYCLICS

Background. Selective serotonin reuptake inhibitors (SSRIs) are more e xpensive than tricyclics. Reports have suggested that SSRIs are cost-e ffective because they are better tolerated and safer in overdose. Meth od. A systematic review of all randomised controlled trials (RCTs), me ta-analyses, and cost-effectiveness studies comparing SSRIs and tricyc lic antidepressants (TCAs). Results. None of the RCTs provided an econ omic analysis and there were methodological problems in the majority w hich would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs d rop out of RCTs. Cost-effectiveness studies have been based on crude ' modelling' approaches and over-estimate the difference in attrition ra tes and the cost of treatment failure. It appears impossible to evalua te the economic aspects of suicide because of its rarity. Conclusions. There is no evidence to suggest that SSRIs are more cost-effective th an TCAs. The debate will only be concluded when a prospective cost-eff ectiveness study is done in the setting of a large primary care based RCT.