title: Pharmacological treatment of depression with and without headache disorders: an appraisal of cost effectiveness and cost utility of antidepressants.
abstract: BACKGROUND
  Depression and headache are highly prevalent in clinical settings. The co-occurrence of headache may impact choice of antidepressants, healthcare utilisation, and outcomes in patients with depression. The current study aims to examine the cost-effectiveness and cost-utility of different antidepressants for treating patients with depression and comorbid headache disorders.
  
  
  METHODS
  Adult patients prescribed with antidepressants for depression (n=96,501) were identified from the National Health Insurance Research Database in Taiwan. A cost-effectiveness and cost-utility analysis was conducted comparing selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), and by the presence of comorbid headache disorders and other pain conditions.
  
  
  RESULTS
  In this study, SSRIs dominated SNRIs in both cost-effectiveness and cost-utility. As revealed in the cost-effectiveness acceptability curves, TCAs were likely to have a cost-utility advantage compared to SSRIs and SNRIs in improving quality-adjusted life years (QALYs) for patients with comorbid headache; SSRIs remained as the most cost-effective option for patients with other pain conditions.
  
  
  CONCLUSIONS
  Limitations include the use of proxy definition of remission as effectiveness measure and the adoption of utility values from previous studies.
  
  
  CONCLUSIONS
  Given a pre-determined willingness-to-pay level, TCAs can be considered as a cost-effective option to improve QALYs for depressed patients with headache disorders. Future research is needed to further clarify factors influencing the cost-effectiveness and cost-utility of pharmacological treatments in depressed patients with specific pain conditions.
authors.affiliation: Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Road., Banciao District, New Taipei City 220, Taiwan; Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King׳s College London, United Kingdom; School of Medicine, National Yang-Ming University, Taiwan. Electronic address: panyiju0211@gmail.com.
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Pan
authors.affiliation: School of Medicine, National Yang-Ming University, Taiwan; Division of Medical Imaging, Far Eastern Memorial Hospital, Taiwan.
authors.forename: Kuei-Hong
authors.initials: KH
authors.lastname: Kuo
authors.affiliation: School of Medicine, National Yang-Ming University, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taiwan.
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy* / Q000191:economics; D005260:Female; D020773:Headache Disorders / Q000150:complications* / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressant; Cost-effectiveness; Cost-utility; Depression; Headache