Department of Neuropsychiatry, Keio University School of Medicine, Center for Stress Research, Keio University, Tokyo, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Psychiatry Clin Neurosci. 2019 Jul;73(7):400-408. doi: 10.1111/pcn.12851. Epub 2019 May 10.
Previous studies indicate that mirtazapine is unique in its quick responsiveness compared to other antidepressants. Although some other studies have evaluated its cost-effectiveness, they have not considered its early stage remission rate. The aim of this study was to address this research gap by using precise clinical data to evaluate the cost-effectiveness of mirtazapine in Japan.
We developed a Markov model to reflect the week-by-week transition probabilities. The Markov cycle was set as 1 week. While our clinical parameters were obtained largely from existing meta-analyses, cost data were derived from government reports. Cost-effectiveness was evaluated by incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year estimated based on the probability sensitivity analyses. The ICERs were estimated at 2, 8, 26, and 52 weeks.
In severe depression, the ICERs ranged between JPY 872 153 and 1 772 723. The probability of mirtazapine being cost-effective ranged from 0.75 to 0.99 when the ICER threshold was JPY 5 000 000. In moderate depression, the ICERs ranged between JPY 2 356 499 and 4 770 145. The probability of mirtazapine being cost-effective ranged from 0.55 to 0.83 when the ICER threshold was JPY 5 000 000.
When considering the early stage efficacy of mirtazapine, it appeared to be cost-effective compared to selective serotonin reuptake inhibitors, especially for severe depression and in the early stage treatment in the Japanese setting. However, our study has some limitations. First, mirtazapine is compared with batched selective serotonin reuptake inhibitors rather than individual ones. Second, we did not consider antidepressant combination therapy as treatment options.
先前的研究表明，与其他抗抑郁药相比，米氮平的反应速度更快，具有独特性。尽管其他一些研究已经评估了其成本效益，但它们没有考虑其早期缓解率。本研究旨在通过使用精确的临床数据来评估米氮平在日本的成本效益，以填补这一研究空白。
我们开发了一个马尔可夫模型来反映每周的转移概率。马尔可夫周期设定为 1 周。虽然我们的临床参数主要来自现有的荟萃分析，但成本数据来自政府报告。基于概率敏感性分析，根据质量调整生命年来评估增量成本效益比（ICER），以评估成本效益。ICER 在 2、8、26 和 52 周时进行了估计。
在重度抑郁症中，ICER 范围在 872153 日元至 1772723 日元之间。当 ICER 阈值为 500 万日元时，米氮平具有成本效益的概率在 0.75 至 0.99 之间。在中度抑郁症中，ICER 范围在 2356499 日元至 4770145 日元之间。当 ICER 阈值为 500 万日元时，米氮平具有成本效益的概率在 0.55 至 0.83 之间。
考虑到米氮平的早期疗效，与选择性 5-羟色胺再摄取抑制剂相比，它在日本环境中似乎具有成本效益，尤其是在重度抑郁症和早期治疗中。然而，我们的研究存在一些局限性。首先，米氮平是与批量选择性 5-羟色胺再摄取抑制剂相比，而不是与个别选择性 5-羟色胺再摄取抑制剂相比。其次，我们没有考虑抗抑郁药联合治疗作为治疗选择。
