title: Cost-effectiveness evaluation in Sweden of escitalopram compared with venlafaxine extended-release as first-line treatment in major depressive disorder.
abstract: OBJECTIVE
  Major depressive disorder (MDD) is a major public health concern associated with a high burden to society, the health-care system, and patients and an estimated cost of €3.5 billion in Sweden. The objective of this study was to assess the cost-effectiveness of escitalopram versus generic venlafaxine extended-release (XR) in MDD, accounting for the full clinical profile of each, adopting the Swedish societal perspective, and identifying major cost drivers.
  
  
  METHODS
  Cost-effectiveness of escitalopram versus venlafaxine XR was analyzed over a 6-month time frame, on the basis of a decision tree, for patients with MDD seeking primary care treatment in Sweden. Effectiveness outcomes for the model were quality-adjusted life-years and probability of sustained remission after acute treatment (first 8 weeks) and sustained for 6 months. Cost outcomes included direct treatment costs and indirect costs associated with sick leave.
  
  
  RESULTS
  Compared with generic venlafaxine XR, escitalopram was less costly and more effective in terms of quality-adjusted life-years (expected gain 0.00865) and expected 6-month sustained remission probability (incremental gain 0.0374). The better tolerability profile of escitalopram contributed to higher expected quality-adjusted life-years and lower health-care resource utilization in terms of pharmacological treatment of adverse events (though only a minor component of treatment costs). Expected per-patient saving was €169.15 for escitalopram versus venlafaxine. Cost from sick leave constituted about 85% of total costs.
  
  
  CONCLUSIONS
  Escitalopram was estimated as more effective and cost saving than generic venlafaxine XR in first-line MDD treatment in Sweden, driven by the effectiveness and tolerability advantages of escitalopram. The study findings are robust and in line with similar pharmacoeconomic analyses.
authors.affiliation: Psykiatriska kliniken, Hedvägen Trelleborg, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Nordström
authors.forename: Natalya
authors.initials: N
authors.lastname: Danchenko
authors.forename: Nicolas
authors.initials: N
authors.lastname: Despiegel
authors.forename: Florence
authors.initials: F
authors.lastname: Marteau
mesh_terms: 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; D003663:Decision Trees; D003692:Delayed-Action Preparations / Q000191:economics*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D017850:Economics, Pharmaceutical; D006801:Humans; D019057:Quality-Adjusted Life Years; D013548:Sweden; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride