Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2012;7(8):e42003. doi: 10.1371/journal.pone.0042003. Epub 2012 Aug 2.
To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression.
A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine). The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year.
Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources.
The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine.
Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.
确定在初级保健中对中重度抑郁症患者进行一线药物治疗的有效性和成本效益，时间范围为一年。
采用多种治疗比较荟萃分析来确定 10 种抗抑郁药（西酞普兰、度洛西汀、依他普仑、氟西汀、氟伏沙明、米氮平、帕罗西汀、瑞波西汀、舍曲林和文拉法辛）在缓解方面的相对疗效。然后，将估计的缓解率应用于决策分析模型中，以估算不同治疗方案在一年内的成本和生活质量。
随机对照试验缓解率的荟萃分析，以及来自已发表来源的成本和生活质量数据。
在缓解方面，依他普仑是最有利的药物治疗方法，8-12 周的缓解概率为 0.47。尽管收购成本较高，但这种临床疗效使依他普仑在社会角度来看，不仅更有效，而且总成本低于所有其他对照药物。从医疗保健角度来看，依他普仑的每 QALY 成本为 3732 欧元，而文拉法辛为 3732 欧元。
在所研究的抗抑郁药中，依他普仑具有最高的缓解率，在初级保健环境中，依他普仑是最有效和最具成本效益的药物治疗方法，在一年的时间范围内进行评估。在评估抗抑郁药的成本和成本效益时，缓解率的微小差异可能很重要。
