title: Economic evaluation of antidepressive agents: a systematic critique of experimental and observational studies.
abstract: The purpose of this study was to examine whether experimental and observational pharmacoeconomic analyses of antidepressant drugs support the choice of one of the selective serotonin reuptake inhibitors or newer antidepressants as first-line treatment for patients with major depression. We systematically reviewed economic evaluations of two or more antidepressants completed in clinical practice. A systematic electronic search yielded 38 studies meeting the inclusion criteria, of which 23 were administrative database analyses, 12 were observational studies, and 3 were randomized clinical trials. Experimental data indicated that tricyclic antidepressants are equivalent to selective serotonin reuptake inhibitors in terms of total expenditure. While the database analyses are susceptible to bias and confounding variables, they provided an added dimension based on observations from everyday clinical practice. The majority of these studies failed to show any significant difference. Taken together, available pharmacoeconomic studies indicate that tricyclic drugs and selective serotonin reuptake inhibitors have similar cost effectiveness in the health care systems where these comparisons have been made.
authors.affiliation: Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Italy. corrado.barbui@univr.it
authors.forename: Corrado
authors.initials: C
authors.lastname: Barbui
authors.forename: Mauro
authors.initials: M
authors.lastname: Percudani
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D017850:Economics, Pharmaceutical; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors