Department of Mental Health, Fatebenefratelli Hospital, Milan, Italy.
Adv Ther. 2013 Jul;30(7):697-712. doi: 10.1007/s12325-013-0046-z. Epub 2013 Aug 9.
Major depressive disorder (MDD) is a common and disabling condition across the world. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly used antidepressants. The objective of this study was to assess the cost-effectiveness [€ per quality-adjusted life year (QALY)] of all SSRIs and all SNRIs for the treatment of MDD in Italy.
A decision analytic model was adapted from the Swedish Dental and Pharmaceutical Benefits agency model to reflect current clinical practice in the treatment of MDD in the largest Italian regions. This adaptation was possible thanks to the collaboration of an expert panel of Italian psychiatrists and health economists. The model evaluated patients with a first diagnosis of MDD and initiating an SSRI or an SNRI for the first time. The time horizon was 12 months. Efficacy and utility data for the model were retrieved from the literature and validated by the expert panel. Local data were considered for resource utilization and for treatment costs based on each regional health service perspective. Population-weighted regional data were used to define a national model. Scenario simulations, one-way sensitivity analyses, and Monte Carlo simulations were performed to test the robustness of the model.
The base case analysis showed that escitalopram was associated with a lower total cost (€ 1,562) and a larger health gain (QALYs) at 1 year (0.732) per patient and dominated the other treatment strategies since more QALYs were achieved at a lower total cost. Sensitivity analyses support the robustness of the model.
The results indicate that escitalopram is the most cost-effective pharmacological treatment strategy for the Italian health service compared with other SSRIs and all SNRIs used in the first-line treatment of MDD.
重度抑郁症（MDD）是全球常见且致残的疾病。选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）是最常用的抗抑郁药。本研究旨在评估所有 SSRIs 和所有 SNRIs 治疗意大利 MDD 的成本效益[每质量调整生命年（QALY）的欧元（€）]。
从瑞典牙科和制药福利机构的模型中改编了一个决策分析模型，以反映意大利最大地区治疗 MDD 中的当前临床实践。由于意大利精神病学家和卫生经济学家专家小组的合作，这种改编成为可能。该模型评估了首次诊断为 MDD 并首次开始使用 SSRIs 或 SNRIs 的患者。时间范围为 12 个月。模型的疗效和效用数据来自文献，并由专家小组验证。资源利用和基于每个区域卫生服务视角的治疗成本考虑了当地数据。使用加权人群的区域数据定义了全国模型。进行了情景模拟、单因素敏感性分析和蒙特卡罗模拟，以测试模型的稳健性。
基础情况分析表明，依他普仑的总成本（€1562）较低，且 1 年内的健康收益（QALY）较大（每位患者 0.732），与其他治疗策略相比具有优势，因为总成本较低但能获得更多的 QALY。敏感性分析支持模型的稳健性。
结果表明，与用于 MDD 一线治疗的其他 SSRIs 和所有 SNRIs 相比，依他普仑是意大利卫生服务最具成本效益的药物治疗策略。
