title: Cost-effectiveness of adjunctive therapy with atypical antipsychotics for acute treatment of major depressive disorder.
abstract: BACKGROUND
  While the clinical utility of atypical antipsychotics has been established in patients with major depressive disorder (MDD) who are refractory to antidepressant therapy, their cost-effectiveness is unknown.
  
  
  OBJECTIVE
  To examine the cost-effectiveness of aripiprazole, quetiapine, and olanzapine/fluoxetine in adults with MDD who are refractory to antidepressant therapy.
  
  
  METHODS
  Using techniques of decision analysis, we estimated expected outcomes and costs over 6 weeks in adults with MDD receiving (1) aripiprazole 2-20 mg/day and antidepressant therapy; (2) quetiapine 150 mg/day or 300 mg/day and antidepressant therapy; (3) the fixed-dose combination of olanzapine 6, 12, or 18 mg/day with fluoxetine 50 mg/day; or (4) antidepressant therapy alone. Cost-effectiveness was assessed in terms of the cost per additional responder at 6 weeks, defined as the ratio of the difference in the cost of MDD-related care over 6 weeks versus antidepressant therapy alone to the difference in the number of patients achieving clinical response by 6 weeks. We estimated the model using data from Phase 3 clinical trials of atypical antipsychotics along with other secondary data sources.
  
  
  RESULTS
  With antidepressant therapy alone, the estimated clinical response rate at 6 weeks was 30%. Aripiprazole, quetiapine 150 mg/day, quetiapine 300 mg/day, and olanzapine/fluoxetine were estimated to increase clinical response at 6 weeks to 49%, 34%, 38%, and 45%, respectively. Costs of MDD-related care over 6 weeks were estimated to be $192 for antidepressant therapy, $847 for aripiprazole, $541 for quetiapine 150 mg/day, $672 for quetiapine 300 mg/day plus antidepressant therapy, and $791 for olanzapine/fluoxetine. Costs per additional responder (vs antidepressant therapy) over a 6-week period were estimated to be $3447 for aripiprazole, $8725 for quetiapine 150 mg/day, $6000 for quetiapine 300 mg/day, and $3993 for olanzapine/fluoxetine.
  
  
  CONCLUSIONS
  Atypical antipsychotics substantially increase clinical response at 6 weeks. Cost per additional responder is lower for aripiprazole than for quetiapine or olanzapine/fluoxetine.
authors.affiliation: Policy Analysis Inc., Brookline, MA, USA.
authors.forename: Charu
authors.initials: C
authors.lastname: Taneja
authors.forename: George I
authors.initials: GI
authors.lastname: Papakostas
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Jing
authors.forename: Ross A
authors.initials: RA
authors.lastname: Baker
authors.forename: Robert A
authors.initials: RA
authors.lastname: Forbes
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D004338:Drug Combinations; D016527:Drug Costs / Q000706:statistics & numerical data; D004351:Drug Resistance; D005473:Fluoxetine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D010879:Piperazines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D004338:Drug Combinations; D010879:Piperazines; D015363:Quinolones; C492572:olanzapine-fluoxetine combination; D005473:Fluoxetine; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole