A probabilistic cost-effectiveness analysis of escitalopram, generic citalopram and venlafaxine as a first-line treatment of major depressive disorder in the UK.
OBJECTIVE
To determine if escitalopram is cost-effective in the UK when compared with venlafaxine and generic citalopram in primary care treatment of Major Depressive Disorder (MDD).


METHODS
A pre-existing cost-effectiveness model was adapted to reflect the practice in the UK. Adult patients (> 18 years) with MDD [baseline scores >/= 18 and </= 40 on the Montgomery-Asberg Depression Rating Scale (MADRS)] were accepted into the decision model. Success rates were derived from a meta-analysis of RCTs and other clinical and cost data from the General Practice Research Database, published literature and expert opinion. Patients were considered to be in remission when their MADRS score was </= 12. Failures were referred to consultant psychiatrists for secondary care. Analytic perspectives included those of society and of the National Health Service (NHS). Indirect costs were calculated using a Human Capital approach based on the average wage.


RESULTS
Expected costs were lower (pounds sterling 465 vs. pounds sterling 544) and successes were higher (63.5% vs. 58.2%) with escitalopram than citalopram. Expected costs/successfully treated patient for escitalopram and citalopram were pounds sterling 732 and pounds sterling 933, respectively, from the NHS perspective and pounds sterling 3635 and pounds sterling 4519, respectively, from the societal perspective. In both cases, escitalopram dominated citalopram. Escitalopram's success rate was similar to that of venlafaxine, but at lower costs (range of savings with escitalopram: pounds sterling 53- pounds sterling 61), just dominating venlafaxine. Robustness of findings was assessed in multivariate sensitivity analyses.


CONCLUSIONS
In primary care in the UK, escitalopram is cost-effective compared with citalopram and quite similar to venlafaxine in treating MDD.
Wade
Alan G
AG
CPS Research, Glasgow, UK.
Toumi
Idris
I
Hemels
Michiel E H
ME
D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use*; D015283:Citalopram / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003511:Cyclohexanols / Q000191:economics* / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride