Pharmacoeconomic analysis of sertraline treatment of depression in patients with unstable angina or a recent myocardial infarction.
BACKGROUND
The prevalence of major depressive disorder in patients with acute coronary syndromes (ACSs) is high and associated with worse cardiovascular outcomes and higher health care costs. Sertraline is the only treatment for major depressive disorder studied in a placebo-controlled trial of patients with ACS and found to be safe and effective. The cost implications of providing antidepressant treatment in this population have not yet been examined. The objective was to evaluate from a payer perspective the potential reduction in costs and psychiatric and cardiovascular events and procedures following sertraline versus placebo treatment of major depressive disorder in patients hospitalized for ACS.


METHODS
Data were analyzed from a randomized, double-blind, placebo-controlled 24-week trial (Sertraline Antidepressant Heart Attack Randomized Trial) of sertraline treatment for major depressive disorder in patients hospitalized for ACS. Main outcome measures included frequency and costs (derived from Medicare diagnosis-related group fee schedules) of psychiatric and cardiovascular events occurring during the treatment period.


RESULTS
There was a trend toward significantly fewer psychiatric or cardiovascular hospitalizations in the sertraline compared with the placebo group (55/186 vs. 76/183; p = .054). The mean per patient cost associated with psychiatric and medical events over the course of treatment was 2733 US dollars for sertraline and 3326 US dollars for placebo, but the difference was not statistically significant (p = .32). After including the costs of the sertra-line (360 US dollars over 24 weeks), there was no increase in treatment costs for sertraline compared with placebo.


CONCLUSIONS
Sertraline treatment of major depressive disorder following hospitalization for a recent myocardial infarction or unstable angina appears to be a cost-effective strategy.
O'Connor
Christopher M
CM
Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Glassman
Alexander H
AH
Harrison
David J
DJ
D000789:Angina, Unstable / Q000191:economics / Q000523:psychology* / Q000628:therapy; D006328:Cardiac Catheterization / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D003953:Diagnosis-Related Groups / Q000191:economics; D004311:Double-Blind Method; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005245:Fee Schedules; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000523:psychology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use*; D020280:Sertraline / Q000191:economics / Q000627:therapeutic use*
D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline