H. Freeman et al., Pharmacoeconomic analysis of antidepressants for major depressive disorderin the United Kingdom, PHARMACOECO, 18(2), 2000, pp. 143-148
Objective: To estimate the cost effectiveness of different classes of antid
epressants in the UK National Health Service.
Design, patients and interventions: The use of the serotonin (5-hydroxyhypt
amine; 5-HT) and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) v
enlafaxine was compared with that of selective serotonin reuptake inhibitor
s (SSRIs) and tricyclic antidepressants (TCAs) in patients with major depre
ssive disorder (MDD). A meta-analysis determined the clinical success rate,
and a decision tree was constructed by interviewing general practitioners
and psychiatrists. Adding pharmacological and nonpharmacological treatment
costs, meta-analytic rates were applied to the decision tree to calculate t
he expected cost and outcome for each drug. Cost effectiveness was determin
ed using a composite measure of outcome [symptom-free days (SFD)].
Main outcome measures and results: The meta-analysis included data from 44
studies on 4033 patients. The highest overall efficacy rate for outpatients
with MDD was with venlafaxine use (73.7%), compared with 61.4% for SSRIs a
nd 59.3% for TCAs. Treatment with venlafaxine yielded the lowest outpatient
cost for a SFD (pound 10.53), compared with pound 13.23 for SSRIs and poun
d 15.52 for TCAs (1998 values).
Conclusions: Using this economic model, venlafaxine appears to be a cost-ef
fective treatment for outpatients with MDD in the UK.