Course and cost of treatment for depression with fluoxetine, paroxetine, and sertraline

Objective: To compare depression-related treatment costs and total healthca re costs for patients diagnosed with depression and treated with either ser traline, paroxetine, or fluoxetine. Patients and Methods: Claims records from a national database of patients d iagnosed with depression who began treatment with an SSRI in 1995. followin g an antidepressant medication-free period of at least 6 months, were inclu ded. Treatment course and associated depression-related treatment and total healthcare costs during the subsequent 12-month treatment period were exam ined using univariate and multivariate methods. Results: Nine hundred five (905) patients taking sertraline, 492 on paroxet ine, and 945 on fluoxetine met inclusion criteria. The groups were similar and representative with respect to gender and age. Mean dose over the 12-mo nth treatment period increased 24%, indicating significant titration in all cohorts. Patients treated with paroxetine had shorter treatment duration ( 157.0 days) than did patients treated with fluoxetine (192.6 days) or sertr aline (166.9 days, P < 0.001). Patients receiving index treatment with paro xetine were most likely to switch to another SSRI (21.3%); those taking ser traline were second most likely to switch (16.1%); and those on fluoxetine were least likely (12.4%, P = 0.001). Mean costs for depression-related out patient visits and hospitalizations were similar. Mean antidepressant presc ription costs differed, being $586, $419, and $446 for fluoxetine, paroxeti ne and sertraline cohorts, respectively (P < 0.001). In this sample, the fl uoxetine cohort did not have lower nonpharmaceutical healthcare costs to of fset higher pharmaceutical acquisition costs. Conclusions from median and m ultivariate analyses were robust to these findings. Conclusions: During this study period when fluoxetine, paroxetine, and sert raline were all well-established agents, similar depression-related treatme nt courses and cost characteristics among all 3 drugs were observed.