Lanterna Rally

Author: Devidas Menon

Publisher:

Published: 1997

Total Pages: 48

ISBN-13:

Recent years have witnessed large increase in expenditures on antidepressants. This has coincided with the introduction and the widespread use of a new class of antidepressants, the selective serotonin reuptake inhibitors (SSRIs). SSRIs are substantially more expensive than the older tricyclic antidepressants (TCAs), but have a different adverse effect profile and are better tolerated. This study examines the cost-effectiveness of this new class of antidepressants as compared to TCAs in the outpatient treatment of depression. A decision model is built in order to compare three different strategies. The first strategy consists of an SSRI followed by a TCA in case of failure, the second strategy consists of a TCA followed by an SSRI in case of failure, and the third strategy consists of TCA only. The model indicates that the success rate of a short term treatment with an SSRI is higher than one with a TCA, but is also more expensive. However, as maintenance therapy is initiated, and the switch of medications is allowed for those who drop out of treatment, the cumulative success rate of SSRI first strategy becomes very similar to that of the TCA first strategy, but the cost of the SSRI first strategy increases over time. In comparison, when estimates of drop-out rates taken from studies conducted in naturalistic environments are substituted for clinical trial rates, this additional cost becomes increasingly small. If quality of life is considered, the SSRI first strategy offers improved quality of life over the TCA first strategy. In other words, an SSRI first-line strategy is dominant over a TCA only strategy, and an SSRI first-line strategy compared to a SSRI second-line strategy produces QALYs at an acceptable cost by current standards.