Cost-utility comparison of escitalopram and sertraline in the treatment of major depressive disorder.
OBJECTIVE
To construct a cost-utility model comparing escitalopram with sertraline in the treatment of major depressive disorders.


METHODS
A decision analytic model was created to compare the cost-utility of these two antidepressants from the perspective of a managed-care organization. The model was designed to compare 10-20 mg/day of escitalopram to 50-200 mg/day of sertraline. Benefits (utility) scores were calculated based on clinical and utility data obtained from the literature. Direct medical costs included costs of the antidepressants, titration, treatment failures, and adverse events. Costs and benefits were modeled for a 6-month period and the model was subjected to thorough sensitivity analyses.


RESULTS
The estimated 6-month total cost was 919 dollars for escitalopram and 1351 dollars for sertraline. The estimated QALYs were 0.40296 for escitalopram and 0.39268 for sertraline. These differences were mostly due to differences in drug acquisition costs and adverse events. The robustness of the cost-utility model results were tested in a Monte Carlo simulation of 10 000 patients and it indicated an 88.5% probability that escitalopram was the dominant therapy, suggesting both lower costs and greater QALYs.


CONCLUSIONS
This cost-utility model that incorporated the costs of titration and impact of side-effects comparing escitalopram 10-20 mg per day and sertraline 50-200 mg per day shows that escitalopram appeared to be less costly and produced efficacy (utility) at least as good as and maybe slightly better than that of sertraline.
Armstrong
Edward P
EP
University of Arizona College of Pharmacy, Tucson, AZ 85721, USA. Armstrong@pharmacy.arizona.edu
Skrepnek
Grant H
GH
Haim Erder
M
M
D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics*; D003967:Diarrhea / Q000139:chemically induced / Q000191:economics; D016527:Drug Costs; D007172:Erectile Dysfunction / Q000139:chemically induced / Q000191:economics; D005260:Female; D006261:Headache / Q000139:chemically induced / Q000191:economics; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D009325:Nausea / Q000139:chemically induced / Q000191:economics; D009819:Office Visits / Q000191:economics; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D020280:Sertraline / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced / Q000191:economics
D000928:Antidepressive Agents; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline