Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine: randomised controlled trial.
BACKGROUND
The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.


OBJECTIVE
To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.


METHODS
An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.


RESULTS
No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3-29.0) for TCAs, 28.3 (95% CI 24.3-32.2) for SSRIs and 24.6 (95% CI 20.6-28.9) for lofepramine. Mean health service costs per patient were pound 762 (95% CI 553-1059) for TCAs, pound 875 (95% CI 675-1355) for SSRIs and pound 867 (95% CI 634-1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).


CONCLUSIONS
The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.
Primary Medical Care Group, Community Clinical Sciences Division, University of Southampton Medical School, Aldermoor Health Centre, Southampton SO16 5ST, UK. ark1@soton.ac.uk
Tony
T
Kendrick
Robert
R
Peveler
Louise
L
Longworth
David
D
Baldwin
Michael
M
Moore
Judy
J
Chatwin
Andrew
A
Thornett
Jonathan
J
Goddard
Michael
M
Campbell
Helen
H
Smith
Martin
M
Buxton
Christopher
C
Thompson
D000293:Adolescent; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008127:Lofepramine / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics; D011446:Prospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
D000929:Antidepressive Agents, Tricyclic; D008127:Lofepramine; D017367:Selective Serotonin Reuptake Inhibitors