The cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder.
OBJECTIVE
The Prevention of Recurrent Episodes of Depression with venlafaxine XR for Two Years trial has reported advantages with maintenance treatment for patients with recurrent depressive disorder. The aim of this study was to assess the cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder, based on a recent clinical trial.


METHODS
A Markov simulation model was constructed to assess the cost-utility of maintenance treatment for 2 years in recurrently depressed patients in Sweden. Risk of relapse and recurrence was based on a recent randomised clinical trial assessing the efficacy and tolerability of maintenance treatment with venlafaxine over 2 years. Costs and quality of life estimations were retrieved from a naturalistic longitudinal observational study conducted in Sweden. Health effects were quantified as quality-adjusted life-years (QALYs). Sensitivity analyses were conducted on key parameters employed in the model.


RESULTS
In the base-case analysis, the cost per QALY gained of venlafaxine compared with no treatment was estimated at $18,500 over 2 years. In a probabilistic sensitivity analysis, we found that maintenance treatment with venlafaxine is cost-effective with 90% probability at a willingness to pay per QALY of $67,000 or less. Our long-term analyses also indicate that even under conservative assumptions about future risks of recurrences, maintenance treatment is cost-effective.


CONCLUSIONS
The present study indicates that maintenance treatment for 2 years with venlafaxine is cost-effective in patients with recurrent major depressive disorder.
Sobocki
P
P
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Ekman
M
M
Ovanfors
A
A
Khandker
R
R
Jönsson
B
B
D018687:Antidepressive Agents, Second-Generation / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003511:Cyclohexanols / Q000191:economics / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D004311:Double-Blind Method; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012307:Risk Factors; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D000069470:Venlafaxine Hydrochloride