Freeman H, Arikian S, Lenox-Smith A
Green College, Oxford, England.
Pharmacoeconomics. 2000 Aug;18(2):143-8. doi: 10.2165/00019053-200018020-00004.
To estimate the cost effectiveness of different classes of antidepressants in the UK National Health Service. DESIGN, PATIENTS AND INTERVENTIONS: The use of the serotonin (5-hydroxytryptamine; 5-HT) and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) venlafaxine was compared with that of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) in patients with major depressive disorder (MDD). A meta-analysis determined the clinical success rate, and a decision tree was constructed by interviewing general practitioners and psychiatrists. Adding pharmacological and nonpharmacological treatment costs, meta-analytic rates were applied to the decision tree to calculate the expected cost and outcome for each drug. Cost effectiveness was determined using a composite measure of outcome [symptom-free days (SFD)].
The meta-analysis included data from 44 studies on 4033 patients. The highest overall efficacy rate for outpatients with MDD was with venlafaxine use (73.7%), compared with 61.4% for SSRIs and 59.3% for TCAs. Treatment with venlafaxine yielded the lowest outpatient cost for a SFD (10.53 Pounds), compared with 13.23 Pounds for SSRIs and 15.52 Pounds for TCAs (1998 values).
Using this economic model, venlafaxine appears to be a cost-effective treatment for outpatients with MDD in the UK.
评估不同种类抗抑郁药在英国国家医疗服务体系中的成本效益。
设计、患者与干预措施：将5-羟色胺（5-羟色胺；5-HT）和去甲肾上腺素再摄取抑制剂（SNRI）文拉法辛与选择性5-羟色胺再摄取抑制剂（SSRI）及三环类抗抑郁药（TCA）在重度抑郁症（MDD）患者中的使用情况进行比较。通过荟萃分析确定临床成功率，并通过访谈全科医生和精神科医生构建决策树。将药物治疗和非药物治疗成本相加，把荟萃分析得出的发生率应用于决策树，以计算每种药物的预期成本和结果。使用综合结果指标[无症状天数（SFD）]来确定成本效益。
荟萃分析纳入了44项研究中4033例患者的数据。MDD门诊患者总体有效率最高的是使用文拉法辛（73.7%），相比之下，SSRI为61.4%，TCA为59.3%。就每一个无症状天数而言，文拉法辛治疗产生的门诊成本最低（10.53英镑），相比之下，SSRI为13.23英镑，TCA为15.52英镑（1998年数值）。
使用这种经济模型，文拉法辛似乎是英国MDD门诊患者的一种具有成本效益的治疗方法。
