Faculty of Pharmacy, Université de Montreal, Montreal, Quebec, Canada.
Value Health. 2011 Jun;14(4):492-8. doi: 10.1016/j.jval.2010.11.015. Epub 2011 Apr 22.
Although for the great majority of indications, practice guidelines recommend that antidepressants (ADs) be used for at least 6 months, premature discontinuation is very frequent in a "real-life" setting. Previous studies have assessed the economic impact of such nonpersistence, but differences across antidepressant products remain inadequately explored.
To compare treatment persistence and incremental cost/persistence ratios (ICPRs) across individual new ADs (selective serotonin reuptake inhibitors and atypical ADs) as well as the associated direct health-care costs in the adult population covered by the public drug program of Quebec.
A retrospective cohort study was conducted in 13,936 adults aged 18 to 64 years who started an AD treatment in 2003. Persistence was defined as treatment duration of at least 6 months regardless of whether a product switch had occurred. Economic impact was assessed over the first year of treatment through drug, medical services, hospitalization, and total health-care costs. Comparisons across products were conducted using the ICPR.
Adjusting for confounders, treatment nonpersistence ranged from 60.4% (paroxetine) to 65.1% (citalopram). The product associated with the highest total health-care costs was citalopram (CDN$2653) and the lowest was venlafaxine (CDN$2168). Fluvoxamine had the lowest mean AD costs (CDN$215) and venlafaxine (CDN$309) the highest.
Total health-care costs were similar across products except for citalopram, which was more costly. Comparisons based on the ICPR revealed that paroxetine, fluoxetine, and venlafaxine were more favorable than the other AD alternatives.
尽管对于绝大多数适应证，实践指南建议抗抑郁药（AD）的使用至少应持续 6 个月，但在“现实生活”环境中，过早停药非常常见。先前的研究已经评估了这种不持续治疗的经济影响，但不同 AD 产品之间的差异仍未得到充分探讨。
比较在魁北克公共药物计划覆盖的成年人群中，个体新型 AD（选择性 5-羟色胺再摄取抑制剂和非典型 AD）的治疗持续性和增量成本/持续性比（ICPR），以及相关的直接医疗保健成本。
对 2003 年开始 AD 治疗的 13936 名 18 至 64 岁成年人进行了回顾性队列研究。无论是否发生产品转换，持续性定义为至少 6 个月的治疗时间。通过药物、医疗服务、住院和总医疗保健成本，在治疗的第一年评估经济影响。使用 ICPR 比较产品之间的差异。
在调整混杂因素后，治疗不持续性范围从 60.4%（帕罗西汀）到 65.1%（西酞普兰）。总医疗保健成本最高的产品是西酞普兰（加元 2653 元），最低的是文拉法辛（加元 2168 元）。氟伏沙明的平均 AD 成本最低（加元 215 元），文拉法辛最高（加元 309 元）。
除西酞普兰外，各产品的总医疗保健成本相似，西酞普兰的成本更高。基于 ICPR 的比较表明，帕罗西汀、氟西汀和文拉法辛比其他 AD 替代品更有利。
