Cost-benefit & cost-effectiveness analysis of the rapid onset of selective serotonin reuptake inhibitors by augmentation.
OBJECTIVE
This article describes a method for evaluating the value of the increased cost of pharmacologic augmentation of an antidepressant.


METHODS
Data to illustrate the method and interpretation of results were derived from a randomized, placebo controlled double blind trial. Eighty outpatients meeting ICD-10 criteria for depressive disorder and scoring > 18 on the Montgomery Asberg Depression Rating Scale (MADRS) were recruited from a primary care population. All patients received SSRI antidepressant and either "augmenting agent" or placebo. The trial period was six weeks, during which the patients were monitored for changes in depressive symptoms using the MADRS. The economic analysis is based only on direct costs of treatment. The analytic approach includes decision analysis, cost-effectiveness and cost-benefit techniques, and a sensitivity analysis.


RESULTS
The economic analysis was performed on both the intention-to-treat and per-protocol population. Intention-to-treat and per-protocol results show that the direct cost of six weeks' treatment with the combination of "augmenting agent" and SSRI antidepressant, if the acceleration effect is taken into account, was more cost effective than the SSRI antidepressant and placebo.


CONCLUSIONS
The direct costs of treatment are higher than those of previous pharmaco-economic studies, but the rate of onset of antidepressant action must be taken into account. The application of the evaluative model appears valid and useful. The model is pragmatic and should be expanded for generalizability.
Tome
M B
MB
United Medical School, University of London.
Isaac
M T
MT
D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D010555:Personality Inventory; D011788:Quality of Life; D011985:Receptors, Serotonin / Q000187:drug effects*; D044263:Receptors, Serotonin, 5-HT1; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
D000928:Antidepressive Agents; D011985:Receptors, Serotonin; D044263:Receptors, Serotonin, 5-HT1; D017367:Selective Serotonin Reuptake Inhibitors