ECONOMIC-EVALUATION OF PAROXETINE AND IMIPRAMINE IN DEPRESSED OUTPATIENTS

In this pilot study, we compared the economic impact of paroxetine and imipramine treatment of depressed outpatients from a university teach ing hospital and a community mental health center. A 12-month retrospe ctive chart review of patients was performed. Clinical outcomes includ ing clinic usage, death, relapse, function, adverse effects, psychiatr ist visits, and drug costs were evaluated. We analyzed drug costs, psy chiatrist costs, and total direct costs using the Mann-Whitney U Test. The incidence of clinic usage, death, function, adverse effects, and psychiatrist visits was similar in patients treated with paroxetine (n =12) and imipramine (n=13). Two patients in the imipramine group were hospitalized once for a total of 5 days compared with none in the paro xetine group. Paroxetine drug costs were significantly higher than imi pramine drug costs. Direct total costs (i.e., drug, psychiatrist visit s, blood levels, and hospitalization costs) did not differ significant ly between the groups based on actual drug usage (paroxetine: median $ 1,432.50 per patient per year; imipramine: median $1,425.81 per patien t per year). Although the median direct total cost per patient per yea r for patients who received 12 months of therapy was lower in the paro xetine group ($1,479.90, n=8) than the imipramine group ($1,503.61, n= 8), the difference was not significant. Our cost minimization analysis revealed no significant difference in the total cost between the two groups. However, the major cost in the paroxetine group was drug cost, whereas the major cost in the imipramine group was hospitalizations. Future large prospective trials are needed to validate these findings.