Fluoxetine and imipramine: are there differences in cost-utility for depression in primary care?
BACKGROUND
Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses.


OBJECTIVE
To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care.


METHODS
A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner's usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out.


RESULTS
Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant.


CONCLUSIONS
Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.
Serrano-Blanco
Antoni
A
Sant Joan de Déu-Serveis de Salut Mental, Fundació Sant Joan de Déu, Sant Boi de Ll, Barcelona, Spain. aserrano@sjd-ssm.com
Suárez
David
D
Pinto-Meza
Alejandra
A
Peñarrubia
Maria T
MT
Haro
Josep Maria
JM
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003863:Depression / Q000188:drug therapy*; D005260:Female; D005473:Fluoxetine / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007099:Imipramine / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011795:Surveys and Questionnaires
D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D005473:Fluoxetine; D007099:Imipramine