title: A multinational pharmacoeconomic evaluation of acute major depressive disorder (MDD): a comparison of cost-effectiveness between venlafaxine, SSRIs and TCAs.
abstract: METHODS
  We conducted a multinational pharmacoeconomic evaluation comparing the immediate release form of a new class of serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine IR to the selective serotonin reuptake inhibitors (SSRIs) and the tricyclic antidepressants (TCAs) in the treatment of acute major depressive disorder (MDD) in 10 countries (Germany, Italy, Netherlands, Poland, Spain, Sweden, Switzerland, United Kingdom, United States, and Venezuela). We designed a decision analytic model assessing the acute phase of MDD treatment within a 6-month time horizon. Six decision tree models were customized with country-specific estimates from a clinical management analysis, meta-analytic rates from two published meta-analyses, and a resource valuation of treatment costs representing the inpatient and outpatient settings within each country. The meta-analyses provided the clinical rates of success defined as a 50% reduction in depression scores on the Hamilton Depression Scale (HAM-D) or the Montgomery-Asberg Depression Rating Scale (MADRS). Treatment regimen costs were determined from standard lists, fee schedules, and communication with local health economists in each country. The meta-analytic rates were applied to the decision analytic model to calculate the expected cost and expected outcomes for each antidepressant 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 examine the health system budget impact in each country of increasing the utilization of the most effective antidepressant found in our study.
  
  
  RESULTS
  Initiating treatment of MDD with venlafaxine IR yielded a lower expected cost compared to the SSRIs and TCAs in all countries except Poland in the inpatient setting, and Italy and Poland within the outpatient settings. The weighted average expected cost per patient varied from US$632 (Poland) to US$5647 (US) in the six-month acute phase treatment of MDD. The estimated total budgetary impact for each 1% of venlafaxine utilization, assuming a population of one million MDD patients, ranged from US$1600 (Italy) to US$29,049 (US).
  
  
  CONCLUSIONS
  Within the inpatient and outpatient treatment settings, venlafaxine IR was a more cost-effective treatment of MDD compared to the SSRIs and TCAs. Additionally, the results of this investigation indicate that increased utilization of venlafaxine in most settings across Europe and the Americas will have favorable impact on health care payer budgets. ADR, adverse drug reaction; CMA, clinical management analysis; ECT, electroconvulsive therapy; HAM-D, Hamilton Depression Scale; MADRS, Montgomery-Asberg depression rating scale; MDD, major depressive disorder; SFD, symptom-free day; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant; WHO, world health organization.
authors.affiliation: Columbia University, School of Public Health, New York, NY, USA. jdoyle@groupanalytica.com
authors.forename: J J
authors.initials: JJ
authors.lastname: Doyle
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: M A
authors.initials: MA
authors.lastname: Gonzalez
authors.forename: R
authors.initials: R
authors.lastname: Casciano
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use; D002017:Budgets; D003362:Cost-Benefit Analysis; D003511:Cyclohexanols / Q000191:economics* / Q000627:therapeutic use; D003663:Decision Trees; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data*; D005060:Europe; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007349:Insurance, Health, Reimbursement; D009010:Monte Carlo Method; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D014687:Venezuela; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride