Differential costs of treatment of depression with SSRIs

Although the field of economic analysis of mental health care is still in development, several issues are now well established. For example, it is generally accepted that the treatment costs for depression are significant, with estimates for the US ranging up to US$43·7 billion. This includes only US$12·4 billion for the costs of treating the patients with depression; the remaining costs are from lost working days, lost income due to suicides, and lost productivity. The high risk of recurrence and chronicity also leads to high direct health care costs. In particular, the frequent and long hospitalizations required for severe depression have an enormous impact in economic terms. The other main costs are related to drug and psychotherapy, and the treatment of side-effects, which are particularly pronounced with the tricyclic antidepressants. Preliminary analyses indicate that the differential tolerability of the current selective serotonin reuptake inhibitors (SSRIs) can also give rise to differences in total costs of treatment. Thus, it can be hypothesized that the relatively favourable side-effect profile of the SSRI fluvoxamine may have positive economic consequences, especially as it is one of the lower priced drugs in this class. Further research based on primary data is needed to substantiate these benefits.