Cost implications of initial antidepressant selection in primary care

Area of Science:

• Pharmacoeconomics
• Clinical Pharmacy
• Health Services Research

Background:

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are often more expensive than tricyclic antidepressants (TCAs).
• Previous research suggests potential reductions in overall medical expenditures with fluoxetine treatment.
• Understanding the total cost of care is crucial for evaluating antidepressant therapies.

Purpose of the Study:

• To compare the overall treatment costs of fluoxetine versus two TCAs (imipramine and desipramine) in primary care.
• To determine if initial fluoxetine prescription impacts total healthcare costs.
• To identify patient subgroups that may benefit from fluoxetine in terms of cost.

Main Methods:

• Analysis of computerized pharmacy and cost-accounting records from a large health plan.
• Inclusion of 5169 primary care patients initiating antidepressant treatment.
• Comparison based on initial medication prescribed, accounting for baseline differences in age, medical comorbidity, and prior costs.

Main Results:

• Initial fluoxetine prescription was associated with higher antidepressant and non-antidepressant health service costs.
• Adjusted non-antidepressant costs were lower in the fluoxetine group but not statistically significant.
• Lower overall costs with fluoxetine were observed primarily in patients with high pretreatment healthcare expenditures.

Conclusions:

• First-line fluoxetine use increases antidepressant drug costs but does not significantly elevate total treatment costs.
• Cost-effectiveness of fluoxetine may be more pronounced in patients with higher baseline medical needs.
• Further pharmacoeconomic evaluations are warranted for antidepressant selection.