title: A pharmacoeconomic evaluation of major depressive disorder (Italy).
abstract: OBJECTIVE
  To determine the most cost-effective oral therapy for the treatment of Major Depressive Disorder (MDD) in Italy.
  
  
  METHODS
  We conducted a pharmacoeconomic evaluation based on a decision analytic model that examined the treatment of major depressive disorder (MDD) in Italy. The analysis compared the serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine extended-release (venlafaxine XR), to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). A meta-analysis was performed to determine the clinical rates of success. The meta-analytic rates were applied to the decision analytic model to calculate the expected cost and expected outcomes for each anti-depressant comparator. Cost-effectiveness was determined using the expected values for both a successful outcome, and a composite measure of outcome termed 'symptom-free days'. A policy analysis was conducted to estimate the financial impact to the Servizio Sanitario Nazionale (SSN).
  
  
  RESULTS
  Treatment of MDD with venlafaxine XR yielded the highest overall efficacy rates for outpatients (73.7%) versus SSRIs (61.4%) and TCAs (59.3%), and inpatients (62.3%) versus SSRIs (58.6%) and TCAs (58.2%). Venlafaxine XR had the lowest dropout rates due to lack of efficacy (4.8%) versus SSRIs (8.4%) and TCAs (6.8%), and adverse drug reactions (10.9%) versus SSRIs (17.4%) and TCAs (23.1%). Initiating treatment of MDD with venlafaxine XR yielded the lowest expected cost for outpatients and for inpatients. The total resulting savings for the SSN at a 5% venlafaxine XR utilization was estimated between L 963 million and L 3,210 million.
  
  
  CONCLUSIONS
  This study confirms that venlafaxine XR is generally a cost-effective treatment of MDD. Additionally, the results of this investigation suggest that increased utilization of venlafaxine XR will favorably impact the SSN.
authors.affiliation: Columbia University, School of Public Health, USA.
authors.forename: J
authors.initials: J
authors.lastname: Casciano
authors.forename: S
authors.initials: S
authors.lastname: Arikian
authors.forename: J E
authors.initials: JE
authors.lastname: Tarride
authors.forename: J J
authors.initials: JJ
authors.lastname: Doyle
authors.forename: R
authors.initials: R
authors.lastname: Casciano
mesh_terms: D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007558:Italy
chemical_list: D000928:Antidepressive Agents