PRESCRIBING SELECTIVE SEROTONIN REUPTAKE INHIBITORS AS STRATEGY FOR PREVENTION OF SUICIDE

Objective-To evaluate a policy to reduce the incidence of suicide by m eans of changing the prescribing of antidepressants from the older tri cycle antidepressants to the routine first line use of selective serot onin reuptake inhibitors or newer tricyclic and related antidepressant s. Design-Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxici ty. Setting-United Kingdom primary care. Interventions-Selective serot onin reuptake inhibitors or newer tricyclic and related antidepressant s compared with the use of older tricyclics. Main outcome measures-Cos t per life saved and cost per Life year saved. Results-The potential n umber of lives which may be saved from a switch to the routine first l ine use of selective serotonin reuptake inhibitors is between 300 and 450 each year. The cost per life year gained ranges from pound 19 000 to pound 173 000, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antide pressants is considerably lower. Conclusions-The cost per life year ga ined through avoiding suicides by the routine first line use of seroto nin reuptake inhibitors is likely to be high. The new tricyclics and r elated drugs are of similar toxicity to the serotonin reuptake inhibit ors but are considerably cheaper and so are more cost effective for th is purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive op tions must be further investigated.