Serrano-Blanco Antoni, Suárez David, Pinto-Meza Alejandra, Peñarrubia Maria T, Haro Josep Maria
Sant Joan de Déu-Serveis de Salut Mental, Fundació Sant Joan de Déu, Sant Boi de Ll, Barcelona, Spain.
J Eval Clin Pract. 2009 Feb;15(1):195-203. doi: 10.1111/j.1365-2753.2008.00982.x.
Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses.
To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care.
A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner's usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out.
Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant.
Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.
抑郁症会带来严重的个人负担和高昂的经济成本。对不同治疗方案进行成本效益分析对政策制定者和临床医生至关重要。以往比较选择性5-羟色胺再摄取抑制剂和三环类抗抑郁药的成本效益研究，采用的是建模技术，或者在经济分析中未纳入间接成本。
确定在基层医疗中，氟西汀与丙咪嗪治疗抑郁症的成本效益。
在西班牙的三个基层医疗中心进行了一项为期6个月的随机前瞻性自然主义研究，比较氟西汀和丙咪嗪。103例因DSM-IV抑郁症需要抗抑郁治疗的患者纳入研究。患者被随机分为氟西汀治疗组（53例）或丙咪嗪治疗组（50例）。患者按照全科医生的常规临床实践接受抗抑郁药治疗。结局指标为欧洲生活质量问卷（EuroQoL-5D，五个维度）的生活质量评分、直接成本、间接成本和总成本。在治疗开始时以及治疗1、3和6个月后对受试者进行评估。获得增量成本效益比（ICUR）。为解决ICUR抽样分布的不确定性，进行了非参数自助法分析。
考虑到调整后的总成本和获得的生活质量增量，在自助法重复抽样中，81.5%的样本显示丙咪嗪优于氟西汀。
在基层医疗中，丙咪嗪似乎是治疗抑郁症更具成本效益的抗抑郁药选择。
