Psykiatriska kliniken, Lasarettet I Trelleborg, Hedvägen Trelleborg, Sweden.
J Med Econ. 2010;13(3):516-26. doi: 10.3111/13696998.2010.506371.
Escitalopram is the S-enantiomer of citalopram and is the most discriminating of the selective serotonin reuptake inhibitors (SSRI). The aim of the current analysis was to assess the cost effectiveness of escitalopram versus the serotonin norepinephrine reuptake inhibitors (SNRI) duloxetine and generic venlafaxine as second-step treatment of major depressive disorder.
The analysis was based on a decision analytic model. Effectiveness outcomes were quality-adjusted life-years (QALYs) and remission rates; cost outcomes were direct medical costs, including impact of treating adverse events, and indirect costs associated with lost productivity. The analysis was performed from the societal perspective in Sweden over a 6-month timeframe.
Estimated remission rates showed an incremental effectiveness in favour of escitalopram of 16.4 percentage points compared with both SNRI comparators. The escitalopram strategy was associated with a 0.025 increase in QALYs. Sensitivity analyses demonstrated that the model is robust and that escitalopram remains a cost-effective option when considering future predicted price reductions of generic venlafaxine.
The main limitation in this study was the lack of data available for second-step treatment. The remission rates, which are a key input to the model, were obtained from a relatively small sample of patients on second-step treatment and there are no published relapse rates for second-step treatment. The model also assumed that there was no difference in the adverse event (AE) rates between treatments after the first 8 weeks.
This cost-effectiveness analysis indicates that, at a willingness-to-pay threshold of £30,000, escitalopram is the most cost-effective second-step treatment option for MDD in Sweden in over 85% cases compared with both venlafaxine and with duloxetine. Benefits for escitalopram included both increased effectiveness and reduced overall costs. The major contributing costs were those associated with productivity loss. The model was shown to have internal validity and robustness through the use of stochastic simulations and sensitivity analyses, which were conducted around the key efficacy parameters.
艾司西酞普兰是西酞普兰的 S-对映体，是选择性 5-羟色胺再摄取抑制剂（SSRIs）中选择性最高的一种。本分析旨在评估艾司西酞普兰与去甲肾上腺素和 5-羟色胺再摄取抑制剂（SNRI）度洛西汀和文拉法辛相比作为治疗重度抑郁症的二线治疗药物的成本效益。
该分析基于决策分析模型。有效性结果为质量调整生命年（QALYs）和缓解率；成本结果为直接医疗成本，包括治疗不良反应的影响和与生产力损失相关的间接成本。该分析是在瑞典以社会为视角，在 6 个月的时间框架内进行的。
估计的缓解率显示，与两种 SNRI 对照药物相比，艾司西酞普兰的额外有效性提高了 16.4 个百分点。艾司西酞普兰策略与 QALYs 增加 0.025 相关。敏感性分析表明，该模型是稳健的，并且当考虑文拉法辛的未来预测价格下降时，艾司西酞普兰仍然是一种具有成本效益的选择。
本研究的主要限制是缺乏二线治疗的数据。模型的关键输入——缓解率是从相对较小的二线治疗患者样本中获得的，并且没有发表二线治疗的复发率。该模型还假设在第 8 周后，治疗之间的不良反应（AE）率没有差异。
这项成本效益分析表明，在愿意支付 30000 英镑的阈值下，艾司西酞普兰在瑞典是治疗 MDD 的二线治疗最具成本效益的选择，在超过 85%的情况下优于文拉法辛和度洛西汀。艾司西酞普兰的好处包括提高疗效和降低总体成本。通过使用随机模拟和敏感性分析，该模型在关键疗效参数周围进行了内部有效性和稳健性的验证。
