title: Course and cost of treatment for depression with fluoxetine, paroxetine, and sertraline.
abstract: OBJECTIVE
  To compare depression-related treatment costs and total healthcare costs for patients diagnosed with depression and treated with either sertraline, paroxetine, or fluoxetine.
  
  
  METHODS
  Claims records from a national database of patients diagnosed with depression who began treatment with an SSRI in 1995, following an antidepressant medication-free period of at least 6 months, were included. Treatment course and associated depression-related treatment and total healthcare costs during the subsequent 12-month treatment period were examined using univariate and multivariate methods.
  
  
  RESULTS
  Nine-hundred five (905) patients taking sertraline, 492 on paroxetine, and 945 on fluoxetine met inclusion criteria. The groups were similar and representative with respect to gender and age. Mean dose over the 12-month treatment period increased 24%, indicating significant titration in all cohorts. Patients treated with paroxetine had shorter treatment duration (157.0 days) than did patients treated with fluoxetine (192.6 days) or sertraline (166.9 days, P < 0.001). Patients receiving index treatment with paroxetine were most likely to switch to another SSRI (21.3%); those taking sertraline were second most likely to switch (16.1%); and those on fluoxetine were least likely (12.4%, P = 0.001). Mean costs for depression-related outpatient visits and hospitalizations were similar. Mean antidepressant prescription costs differed, being $586, $419, and $446 for fluoxetine, paroxetine and sertraline cohorts, respectively (P < 0.001). In this sample, the fluoxetine cohort did not have lower nonpharmaceutical healthcare costs to offset higher pharmaceutical acquisition costs. Conclusions from median and multivariate analyses were robust to these findings.
  
  
  CONCLUSIONS
  During this study period when fluoxetine, paroxetine, and sertraline were all well-established agents, similar depression-related treatment courses and cost characteristics among all 3 drugs were observed.
authors.affiliation: University of Texas Medical Branch, Galveston 77555-0191, USA. jrussell@utmb.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Russell
authors.forename: E R
authors.initials: ER
authors.lastname: Berndt
authors.forename: R
authors.initials: R
authors.lastname: Miceli
authors.forename: S
authors.initials: S
authors.lastname: Colucci
authors.forename: A N
authors.initials: AN
authors.lastname: Grudzinski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics*; D005260:Female; D005473:Fluoxetine / Q000191:economics* / Q000627:therapeutic use; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000191:economics* / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D020280:Sertraline / Q000191:economics* / Q000627:therapeutic use; D014481:United States
chemical_list: D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline