van Baardewijk M, Vis P M J, Einarson T R
Faculty of Pharmacy, University of Utrecht, Netherlands.
Curr Med Res Opin. 2005 Aug;21(8):1271-9. doi: 10.1185/030079905X56484.
To determine the cost effectiveness of duloxetine, a new serotonin norepinephrine reuptake inhibitor, when compared with venlafaxine-XR in treating major depressive disorder.
A cost effectiveness analysis, using a decision tree modelled outpatient treatment over 6 months. Analytic perspectives were those of society (all direct and indirect costs) and the Ministry of Health of Ontario (MoH) as payer for all direct costs. Rates of success and dropouts were obtained from a meta-analysis of randomized placebo-controlled trials. Costs were taken from standard lists, adjusted to 2005 Canadian dollars; discounting was not applied. One-way sensitivity analyses were performed on monthly acquisition costs and success rates; Monte-Carlo analysis examined all parameters over 10000 iterations.
From both perspectives, outcomes all numerically favoured venlafaxine-XR (Expected success = 53% and 57%; symptom-free days [SFDs] = 52.72 and 57.03 for duloxetine and venlafaxine-XR, respectively). Total expected costs/patient treated were, Can dollar 7081 and Can dollar 6551 (MoH), Can dollar 20987 and Can dollar 19 997 (societal perspective), for duloxetine and venlafaxine-XR, respectively. Expected costs/SFD were Can dollar134 and Can dollar 115 (MoH) and Can dollar 398 and Can dollar 351 (societal viewpoint) for duloxetine and venlafaxine-XR, respectively. Although results were sensitive to changes in success rate within the 95% CI, Monte-Carlo analyses using the ICER (incremental cost effectiveness ratio) as outcome found venlafaxine-XR was dominant in approximately 78% of scenarios in both perspectives.
Differences in pharmacoeconomic outcomes found were modest, but in all cases, favoured venlafaxine-XR over duloxetine. Therefore, a possible advantage may exist at the population level in the treatment of major depressive disorder in Canada. Ultimately, a head to head study of the two drugs would be needed to confirm these findings.
比较新型5-羟色胺去甲肾上腺素再摄取抑制剂度洛西汀与文拉法辛缓释剂治疗重度抑郁症的成本效益。
采用决策树模型对6个月的门诊治疗进行成本效益分析。分析视角包括社会视角（所有直接和间接成本）以及安大略省卫生部（MoH）作为所有直接成本支付方的视角。成功和退出率来自随机安慰剂对照试验的荟萃分析。成本取自标准列表，并调整为2005年加拿大元；未应用贴现。对每月购置成本和成功率进行单向敏感性分析；蒙特卡洛分析在10000次迭代中检查所有参数。
从两个视角来看，结果在数值上均有利于文拉法辛缓释剂（预期成功率分别为53%和57%；度洛西汀和文拉法辛缓释剂的无症状天数分别为52.72天和57.03天）。度洛西汀和文拉法辛缓释剂每位接受治疗患者的总预期成本分别为7081加元和6551加元（MoH视角）、20987加元和19997加元（社会视角）。度洛西汀和文拉法辛缓释剂每无症状天数的预期成本分别为134加元和115加元（MoH视角）以及398加元和351加元（社会视角）。尽管结果对95%置信区间内成功率的变化敏感，但使用增量成本效益比（ICER）作为结果的蒙特卡洛分析发现，在两个视角中，约78%的情况下文拉法辛缓释剂占主导地位。
发现的药物经济学结果差异不大，但在所有情况下，文拉法辛缓释剂均优于度洛西汀。因此，在加拿大治疗重度抑郁症的人群层面可能存在优势。最终，需要对这两种药物进行直接比较研究以证实这些发现。
