COST-UTILITY OF MAINTENANCE TREATMENT OF RECURRENT DEPRESSION WITH SERTRALINE VERSUS EPISODIC TREATMENT WITH DOTHIEPIN

The objective of this study was to model, for patients at risk of recu rrent depression, the cost-utility of maintenance therapy with sertral ine compared with treatment of acute episodes with dothiepin ('episodi c treatment'). Using clinical decision analysis techniques, a Markov s tate-transition model was constructed to estimate the lifetime costs a nd quality-adjusted life-years (QALYs) of the 2 therapeutic strategies . The model follows 2 cohorts of 35-year-old women at high risk for re current depression over their lifetimes. Model construction and releva nt data (probabilities) for performing the analysis were based on exis ting clinical knowledge. Two physician panels were used to obtain esti mates of recurrence probabilities not available in the literature, hea lth utilities, and resource consumption. Costs were obtained from publ ished sources. The baseline analysis showed that it costs 2172 Pounds ($US3692, 1991 currency) to save an additional QALY with sertraline ma intenance treatment. Sensitivity analysis showed that the incremental cost-utility ratio ranged from 557 Pounds to 5260 Pounds per QALY. Ove rall, the resulting ratios are considered to be well within the range of cost-utility ratios that support the adoption and appropriate utili sation of a technology. Based on the study assumptions, long term main tenance treatment with sertraline appears to be clinically and economi cally justified choice for patients at high risk of recurrent depressi on.