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Cost-Effective Drug Switch Options After Unsuccessful Treatment With an SSRI for Depression
Ashima Singh1, Maria M Brooks1, Ronald E Voorhees1
1Dr. Singh, Dr. Brooks, Dr. Voorhees, Mr. Luther, and Dr. Wisniewski are with the Department of Epidemiology, and Ms. Potter and Dr. Roberts are with the Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (e-mail: ashimasingh7@gmail.com ).
Psychiatric Services (Washington, D.C.)
|August 16, 2016
Summary
For major depressive disorder, switching to bupropion, sertraline, or venlafaxine after citalopram failure shows similar cost-effectiveness. These alternative antidepressants offer comparable value, regardless of medication choice.
Area of Science:
- Pharmacoeconomics
- Psychiatry
- Clinical Research
Background:
- Major depressive disorder (MDD) often requires treatment adjustments when initial therapies fail.
- Bupropion, sertraline, and venlafaxine are established options for treatment-resistant depression.
- Previous studies indicated comparable therapeutic effectiveness among these agents.
Purpose of the Study:
- To evaluate the cost-effectiveness of switching to bupropion, sertraline, or venlafaxine following inadequate response to citalopram.
- To compare the economic value of these alternative antidepressant treatments.
Main Methods:
- The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial data were analyzed for 727 patients at level 2.
- Patients were randomized to bupropion (n=239), sertraline (n=238), or venlafaxine (n=250).
- Cost-effectiveness was assessed using net health benefits, incorporating medication, concomitant drug, and healthcare utilization costs.
Main Results:
- Mean medication costs were highest for venlafaxine ($968) compared to bupropion ($607) and sertraline ($703).
- No significant differences were found in costs of other medications or healthcare utilization.
- Despite significant overall cost differences (p=.025), pairwise comparisons and net health benefit analyses showed no significant differences in cost-effectiveness among the three switch medications.
Conclusions:
- Switching to bupropion, sertraline, or venlafaxine offers comparable cost-effectiveness for patients with major depressive disorder unresponsive to citalopram.
- Treatment choice among these options may not be driven by economic considerations related to effectiveness.