title: Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.
abstract: OBJECTIVE
  To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression.
  
  
  METHODS
  A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine). The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year.
  
  
  METHODS
  Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources.
  
  
  RESULTS
  The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine.
  
  
  CONCLUSIONS
  Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden. Joakim.ramsberg@vardanalys.se
authors.forename: Joakim
authors.initials: J
authors.lastname: Ramsberg
authors.forename: Christian
authors.initials: C
authors.lastname: Asseburg
authors.forename: Martin
authors.initials: M
authors.lastname: Henriksson
mesh_terms: D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D011320:Primary Health Care / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents