COST-BENEFIT AND COST-EFFECTIVENESS ANALYSIS OF THE RAPID ONSET OF SELECTIVE SELECTIVE REUPTAKE INHIBITORS BY AUGMENTATION

Objective: This article describes a method for evaluating the value oi the increased cost of pharmacologic augmentation of an antidepressant . Method: Data to illustrate the method and interpretation of results were derived from a randomized, placebo controlled double blind trial. Eighty outpatients meeting ICD-10 criteria for depressive disorder an d scoring > 18 on the Montgomery-Asberg Depression Rating Scale (MADRS ) were recruited from a primary care population. All patients received SSRI antidepressant and either ''augmenting agent'' or placebo. The t rial period was six weeks, during which the patients were monitored fo r changes in depressive symptoms using the MADRS. The economic analysi s is based only on direct costs of treatment. The analytic approach in cludes decision analysis, cost-effectiveness and cost-benefit techniqu es, and a sensitivity analysis. Results: The economic analysis was per formed on both the intention-to-treat population and the per-protocol population. Intention-to-treat and per-protocol results show that the direct cost of six weeks' treatment with the combination of ''augmenti ng agent'' and SSRI antidepressant, if the acceleration effect is take n into account, was more cost effective than the SSRI antidepressant a nd placebo. Conclusion: The direct costs of treatment are higher than those of previous pharmaco-economic studies, but the rate of onset of antidepressant action must be taken into account. The; application of the evaluative model appears valid and useful. The model is pragmatic and should be expanded for generalizability.