title: A model to evaluate the cost-effectiveness of oral therapies in the management of patients with major depressive disorders.
abstract: The introduction of a new antidepressant, venlafaxine, a serotonin norepinephrine reuptake inhibitor (SNRI), has provided researchers with the opportunity to take a closer look at the issues involved in selecting a product for a formulary. To aid decision makers in considering the adoption of this new therapy, a pharmacoeconomic simulation model was developed to evaluate the cost-effectiveness of SNRIs versus traditional oral therapies in the management of patients with major depressive disorders (MDDs) from a cost-based payer perspective. Four treatment regimens for MDD were compared: tricyclic antidepressants, selective serotonin reuptake inhibitors, heterocyclic antidepressants, and SNRIs. The principles of decision analysis were used to calculate outcome probabilities based on data from a meta-analysis. The expected cost of each regimen was calculated using cost data from a survey of three health maintenance organizations located in Missouri, Massachusetts, and California. The model suggests that SNRI therapy demonstrates the highest level of cost-effectiveness in an inpatient setting when using both brand and generic acquisition costs of the drugs. When comparing treatment regimens for out-patients, the generic heterocyclic antidepressants demonstrate the highest level of cost-effectiveness: when using band acquisition costs, the SNRIs demonstrate the highest level of cost-effectiveness. Sensitivity analysis calculated the robustness of the conclusions to all major parameters.
authors.affiliation: University of Toronto, Ontario, Canada.
authors.forename: T R
authors.initials: TR
authors.lastname: Einarson
authors.forename: S
authors.initials: S
authors.lastname: Arikian
authors.forename: S
authors.initials: S
authors.lastname: Sweeney
authors.forename: J
authors.initials: J
authors.lastname: Doyle
mesh_terms: D000284:Administration, Oral; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics*; D004359:Drug Therapy, Combination; D017850:Economics, Pharmaceutical; D006801:Humans; D015201:Meta-Analysis as Topic; D018803:Models, Economic; D012680:Sensitivity and Specificity
chemical_list: D000928:Antidepressive Agents