Russell J M, Berndt E R, Miceli R, Colucci S, Grudzinski A N
University of Texas Medical Branch, Galveston 77555-0191, USA.
Am J Manag Care. 1999 May;5(5):597-606.
To compare depression-related treatment costs and total healthcare costs for patients diagnosed with depression and treated with either sertraline, paroxetine, or fluoxetine.
Claims records from a national database of patients diagnosed with depression who began treatment with an SSRI in 1995, following an antidepressant medication-free period of at least 6 months, were included. Treatment course and associated depression-related treatment and total healthcare costs during the subsequent 12-month treatment period were examined using univariate and multivariate methods.
Nine-hundred five (905) patients taking sertraline, 492 on paroxetine, and 945 on fluoxetine met inclusion criteria. The groups were similar and representative with respect to gender and age. Mean dose over the 12-month treatment period increased 24%, indicating significant titration in all cohorts. Patients treated with paroxetine had shorter treatment duration (157.0 days) than did patients treated with fluoxetine (192.6 days) or sertraline (166.9 days, P < 0.001). Patients receiving index treatment with paroxetine were most likely to switch to another SSRI (21.3%); those taking sertraline were second most likely to switch (16.1%); and those on fluoxetine were least likely (12.4%, P = 0.001). Mean costs for depression-related outpatient visits and hospitalizations were similar. Mean antidepressant prescription costs differed, being $586, $419, and $446 for fluoxetine, paroxetine and sertraline cohorts, respectively (P < 0.001). In this sample, the fluoxetine cohort did not have lower nonpharmaceutical healthcare costs to offset higher pharmaceutical acquisition costs. Conclusions from median and multivariate analyses were robust to these findings.
During this study period when fluoxetine, paroxetine, and sertraline were all well-established agents, similar depression-related treatment courses and cost characteristics among all 3 drugs were observed.
比较被诊断为抑郁症并接受舍曲林、帕罗西汀或氟西汀治疗的患者与抑郁症相关的治疗成本和总医疗成本。
纳入1995年开始使用选择性5-羟色胺再摄取抑制剂（SSRI）治疗、且在至少6个月未服用抗抑郁药物后被诊断为抑郁症的患者的全国数据库中的理赔记录。使用单变量和多变量方法检查随后12个月治疗期内的治疗过程以及与抑郁症相关的治疗和总医疗成本。
905名服用舍曲林、492名服用帕罗西汀和945名服用氟西汀的患者符合纳入标准。各组在性别和年龄方面相似且具有代表性。12个月治疗期内的平均剂量增加了24%，表明所有队列中均有显著的剂量滴定。接受帕罗西汀治疗的患者治疗持续时间（157.0天）比接受氟西汀治疗的患者（192.6天）和舍曲林治疗的患者（166.9天）短（P<0.001）。接受帕罗西汀初始治疗的患者最有可能换用另一种SSRI（21.3%）；服用舍曲林的患者其次（16.1%）；服用氟西汀的患者可能性最小（12.4%，P=0.001）。与抑郁症相关的门诊和住院平均费用相似。抗抑郁药物的平均处方费用有所不同，氟西汀、帕罗西汀和舍曲林队列分别为586美元、419美元和446美元（P<0.001）。在该样本中，氟西汀队列没有较低的非药物医疗成本来抵消较高的药物购置成本。中位数和多变量分析的结论对这些发现具有稳健性。
在本研究期间，当氟西汀、帕罗西汀和舍曲林均为成熟药物时，观察到所有三种药物的抑郁症相关治疗过程和成本特征相似。
