title: Benefit of slow titration of paroxetine to treat depression in the elderly.
abstract: OBJECTIVE
  Paroxetine is commonly used to treat depression in the elderly; however, titration issues have been raised. Rapid titration may lead to increased anxiety and early dropout. The aim of this cost-utility analysis was to compare the potential benefit of standard (10 mg the first day) versus slow titration (2.5 mg gradually increased).
  
  
  METHODS
  Clinical analysis was based on a naturalistic trial integrated with a decision-analytic model representing second treatments for those who initially did not respond and for dropout cases. Treatment setting was a public outpatient center for mental disorders in Italy. Service use data were estimated from best practice guidelines, whereas costs (Euros; 2012) were retrieved from Italian official sources.
  
  
  RESULTS
  Slow titration approach produced 0.031 more quality-adjusted life years (remission rate: 57% vs 44% in standard titration group) at an incremental cost of €5.53 (generic paroxetine) and €54.54 (brand paroxetine syrup). Incremental cost-effectiveness ratio (ICER) values were €159 and €1768, respectively, in favor of slow titration approach. Cost-effectiveness threshold, defined as ICER < 1 GDP per capita according to World Health Organization criteria, is about €25 000 in Italy.
  
  
  CONCLUSIONS
  Our results are consistent with a superiority of slow titration of paroxetine in older depressed patients. However, these findings, in part based on simulated data, need to be replicated in clinical trials.
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Olgiati
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bajo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Serretti
mesh_terms: D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage* / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D017374:Paroxetine / Q000008:administration & dosage* / Q000191:economics; D010352:Patient Dropouts; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine
keywords: antidepressants; cost-benefit; depression; paroxetine; pharmacoeconomics