Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide.
OBJECTIVE
To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants.


METHODS
Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity.


METHODS
United Kingdom primary care.


METHODS
Selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics.


METHODS
Cost per life saved and cost per life year saved.


RESULTS
The potential number of lives which may be saved from a switch to the routine first line use of selective serotonin reuptake inhibitors is between 300 and 450 each year. The cost per life year gained ranges from 19,000 pounds to 173,000 pounds, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower.


CONCLUSIONS
The cost per life year gained through avoiding suicides by the routine first line use of serotonin reuptake inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the serotonin reuptake inhibitors but are considerably cheaper and so are most cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.
Freemantle
N
N
NHS Centre for Reviews and Dissemination, University of York.
House
A
A
Song
F
F
Mason
J M
JM
Sheldon
T A
TA
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003863:Depression / Q000188:drug therapy; D016527:Drug Costs; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use*; D013405:Suicide / Q000191:economics; D026712:Value of Life; D000092864:Suicide Prevention
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors