Cost-effectiveness of escitalopram versus citalopram in the treatment of severe depression.
BACKGROUND
Severe depression is associated with an extensive economic burden on both the patient and society.


OBJECTIVE
To estimate the cost-effectiveness in Austria of escitalopram compared with citalopram in the management of severe depression (Montgomery-Asberg Depression Rating Scale score > or =30).


METHODS
A decision model incorporated treatment paths and associated direct resource use (psychiatric hospitalization, medications, general practitioner and psychiatrist visits, treatment discontinuation, suicide attempts) associated with managing severe depression and the indirect cost of work absenteeism over a 6-month period. Main outcomes were clinical success (remission at 6 mo) and cost (2002 Euros equals approximately 1.25 US) of treatment. The analysis was performed from the Austrian societal and Social Healthcare Insurance System (SHIS) perspectives. Clinical input data were derived from a meta-analysis of 8-week randomized clinical trials. Costs were derived from standard Austrian price lists or from the literature.


RESULTS
Six months after the start of treatment, the overall clinical success remission rate was higher for escitalopram (53.7%) than for citalopram (48.7%). From the SHIS perspective, the total expected cost per successfully treated severely depressed patient was 924 (32.1%) lower for escitalopram (2879) compared with citalopram (3803). From the societal perspective, the total expected cost per successfully treated severely depressed patient was 1369 (24.4%) lower for escitalopram (5610) than for citalopram (6979). Sensitivity analyses demonstrated that the model was robust and that, even if citalopram had no acquisition cost, escitalopram remained the dominant strategy for both perspectives.


CONCLUSIONS
Treatment with escitalopram was the dominant strategy. These data suggest that escitalopram is a cost-effective antidepressant compared with citalopram in the management of severe depression in Austria.
Hemels
Michiel E H
ME
International Department of Health Economics and Epidemiology, H. Lundbeck A/S, 37 Avenue Pierre 1er de Serbie, 75008 Paris, France. MEHH@Lundbeck.com
Kasper
Siegfried
S
Walter
Evelyn
E
Einarson
Thomas R
TR
D000041:Absenteeism; D001317:Austria; D015283:Citalopram / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003662:Decision Theory; D003866:Depressive Disorder / Q000188:drug therapy*; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors