Cost-effective treatment of depression with selective serotonin reuptake inhibitors

To compare factors that influence cost of antidepressant therapy between older tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) and among drugs in the SSRI class.

Literature review.

Pharmacoeconomic data from the primary care and managed care settings demonstrate that the higher acquisition cost of the SSRIs is offset by reduced medical utilization because of a lower incidence of treatment-related adverse events, drug switching, and dosage adjustments than among patients taking TCAs. Analysis of pharmacy claims data suggests that drug acquisition costs, use of concomitant medications, incidence of dose titration, frequency of multitablet therapy (dose stratification), and duration of therapy are the key factors in determining the cost of SSRI therapy. Among the established SSRIs, drug acquisition costs are lowest for paroxetine and sertraline. Costs for concomitant medications may vary by healthcare plan. Recent reports indicate that paroxetine is associated with a low incidence of dose titration. Paroxetine and sertraline are available in extended dosage forms to reduce the need for multitablet therapy. Duration of therapy with all SSRIs is typically shorter than recommended.

Antidepressant therapy with SSRIs has been shown to be more cost effective than treatment with TCAs when overall healthcare utilization and expenses are considered.