Ramchandani P, Murray B, Hawton K, House A
Child and Family Psychiatric Service, Sue Nicholls Centre, Manor House, Bierton Road, HP20 1EG, Aylesburg, UK.
J Affect Disord. 2000 Nov;60(2):97-100. doi: 10.1016/s0165-0327(99)00163-9.
Debate continues over the relative merits of tricyclics and selective serotonin re-uptake inhibitors (SSRIs) as first line antidepressant treatment for depression. SSRIs are safer in overdose but more expensive than tricyclics. This report compared the hospital costs of cases of overdose with both groups of drug.
Records of all persons aged over thirteen years presenting to a general hospital in one year were analysed for demographic information and details of their attendance.
There were 1165 episodes of self-poisoning, 151 involving tricyclics as the sole antidepressant and 69 SSRIs as the sole antidepressant. Those taking SSRIs had a shorter (1.96 vs. 2.59 days) and less expensive ( pound330 vs. pound567) stay. A large proportion of this difference in cost was due to a small number of admissions to the Intensive Care Unit.
This study used only hospital costs, so excluding costs associated with primary care.
If there were similar cost differences countrywide, the difference in hospital costs of self poisoning with SSRIs and tricyclics would represent an additional pound3.87 million per year due to self poisoning with tricyclics across the whole of England and Wales. This is a small proportion of the estimated pound100 million cost of switching to first-line prescribing of SSRIs for depression.
关于三环类药物和选择性5-羟色胺再摄取抑制剂（SSRI）作为抑郁症一线抗抑郁治疗药物的相对优点，仍存在争议。SSRI药物过量时更安全，但比三环类药物更昂贵。本报告比较了两组药物过量病例的住院费用。
分析了一家综合医院一年内所有13岁以上患者的记录，以获取人口统计学信息和就诊详情。
共有1165例自我中毒事件，其中151例仅使用三环类药物作为抗抑郁药，69例仅使用SSRI作为抗抑郁药。服用SSRI的患者住院时间较短（1.96天对2.59天）且费用较低（330英镑对567英镑）。费用差异的很大一部分是由于少数患者入住重症监护病房所致。
本研究仅使用了住院费用，因此未包括与初级护理相关的费用。
如果全国范围内存在类似的费用差异，那么在英格兰和威尔士，因三环类药物自我中毒导致的SSRI和三环类药物自我中毒住院费用差异每年将额外增加387万英镑。这只是转向使用SSRI作为抑郁症一线处方估计1亿英镑费用的一小部分。
