Cost-benefit analysis of newer versus older antidepressants - Pharmacoeconomic studies comparing SSRIs/SNRIs with tricyclic antidepressants

Changes in the social and health services over the last years have forced d octors to concern themselves with cost benefit calculations and budget fore casting. Cost considerations are a (co-) determinant in the choice of antid epressants as well as neuroleptics and/or antipsychotics. In recent years, pharmacoeconomic studies have been performed to answer the question as to w hat extent treatment with new antidepressants, in particular SSRls, is actu ally less expensive than treatment with (generic) tricyclic antidepressants due to better safety profiles and higher compliance in spite of the consid erably higher retail price. Following descriptions of the methodological pr inciples, the currently available studies are presented and discussed criti cally in this report. It can be stated that the economic value of different antidepressants can not be decided definitively at the present time. The a vailable data do not allow the conclusion that SSRls should be preferred ov er tricyclic antidepressants with the argument that the treatment as a whol e is more cost effective in spite of the higher costs. Changes in policy on social and health services over the last few years hav e forced office-based physicians (and increasingly also clinic-based physic ians) to concern themselves more with cost benefit calculations and budget estimates. Thus, cost aspects have also become a decisive factor in drug se lection. In the last few years "sociopharmacoeconomic" evaluations have bee n carried out to establish a data base to answer the question of whether th e total cost of treatment with newer antidepressant drugs (especially SSRls ) is the same or lower than that of treatment with (generic) tricyclic prep arations [3]. In particular, these studies have been conducted in view of p otential advantages of newer antidepressants in terms of safety and patient s compliance. Resulting from the introduction of new antidepressant drugs, the costs of a day's treatment now vary widely (the most expensive being roughly five tim es as high as the lowest - see Fig. 1).