[Antidepressant pharmacotherapy: a review of pharmaco-economic research]

Recent pharmacotherapeutic advances in the treatment of depression have included the development of selective serotonin reuptake inhibitors (SSRIs), thereby providing an alternative to tricyclic antidepressants (TCAs). SSRIs have achieved a rapid acceptance by prescribers worldwide due to a superior safety profile to that observed with the TCAs, and the potential for once daily administration. However, to date there exists limited data regarding the effect of antidepressant pharmacotherapy on health service expenditures. Herein, we review the inherent strengths and weaknesses of the five study designs which have been employed in the economic appraisal of antidepressant pharmacotherapy: randomized controlled trials; meta-analyses stemming from the results of controlled clinical trials; decision-analytical models predicated on results stemming from randomized clinical trials and/or meta-analyses; retrospective data archive investigations; and prospective randomized naturalistic inquiry. What emerges is the necessity of establishing a portfolio of evidence as to the safety, efficacy, and effectiveness of a given pharmacotherapeutic category (e.g. SSRIs) and/or a specific medication. Thus, the economic appraisal of antidepressant pharmacotherapy will require an iterative process extending from the developmental through post-marketing phase.