TRICYCLIC ANTIDEPRESSANT AND SELECTIVE SEROTONIN REUPTAKE INHIBITORS ANTIDEPRESSANT SELECTION AND HEALTH-CARE COSTS IN THE NATURALISTIC SETTING - A MULTIVARIATE-ANALYSIS

Background: Providers and payers have an interest in the total health care costs following the initiation of antidepressant treatment in the real world of clinical practice. Analyses of these costs can help eva luate the economic consequences of patient management decisions associ ated with initial antidepressant selection. Objective: The purpose of this study was to assess the 1-year total direct health care costs for patients initiating therapy with one of the available tricyclic antid epressants (TCAs) or one of the three most often prescribed selective serotonin reuptake inhibitors (SSRIs) - paroxetine, sertraline, or flu oxetine. Method: A two-stage multivariate econometric model and data f rom fee-for-service private insurance claims between 1990 and 1994 wer e used to estimate the total direct health care costs following initia l antidepressant drug selection for 2693 patients with a 'new' episode of antidepressant treatment. Results: After controlling for both obse rved and unobserved characteristics, the 1-year total direct health ca re costs were found to be (1) statistically significantly lower for pa tients initiating therapy on fluoxetine than for patients initiating t herapy on a TCA; (2) statistically significantly lower for patients wh o initiated therapy on fluoxetine than for patients initiating therapy on sertraline. Conclusions: Broadly considered, the findings in this study suggest that total direct health care costs differ across initia l antidepressant selection after controlling for both observed and uno bserved characteristics. (C) 1998 Elsevier Science B.V.