The pharmacoeconomics of venlafaxine in depression

The prevalence of depression and the high costs associated with its managem ent have heightened interest in pharmacoeconomic evaluation of drug treatme nt, especially the use of selective serotonin reuptake inhibitors (SSRIs) a nd the serotonin-norepinephrine reuptake inhibitor venlafaxine. A number of studies of venlafaxine in both inpatient and outpatient settings have reve aled that extended-release venlafaxine has a lower expected cost than compa rable treatment with SSRIs and tricyclic antidepressants (TCAs). When the r elative cost effectiveness of immediate-release venlafaxine, SSRIs, and TCA s was assessed in the treatment of major depressive disorder in 10 countrie s, venlafaxine yielded a lower than expected cost compared with SSRIs and T CAs in all but 1 country. In comparing healthcare expenditures for depresse d patients with and without anxiety, there was a pharmacoeconomic benefit t o both immediate- or extended-release venlafaxine, regardless of the presen ce or absence of comorbid anxiety. A review of computerized administrative claims data from 9 US healthcare plans on resource use and the cost of venl afaxine instead of TCAs after switching from an SSRI showed that overall co sts did not vary markedly between venlafaxine and TCAs. This led to the con clusion that although therapy with venlafaxine is more costly than TCA ther apy, this increase may be offset by lower costs of other medical services. Such findings have enormous potential ramifications for practicing physicia ns in terms of venlafaxine's superior remission rate, lower likelihood of r elapse, loss of fewer patients to adverse events or lack of efficacy, and f lexibility in dosing that enables titration to achieve an optimal response.