Hotopf M, Lewis G, Normand C
Department of Psychological Medicine, King's College School of Medicine and Dentistry, London.
Br J Psychiatry. 1996 Apr;168(4):404-9. doi: 10.1192/bjp.168.4.404.
Selective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclics. Reports have suggested that SSRIs are cost-effective because they are better tolerated and safer in overdose.
A systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRIs and tricyclic antidepressants (TCAs).
None of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs drop out of RCTs. Cost-effectiveness studies have been based on crude 'modelling' approaches and over-estimate the difference in attrition rates and the cost of treatment failure. It appears impossible to evaluate the economic aspects of suicide because of its rarity.
There is no evidence to suggest that SSRIs are more cost-effective than TCAs. The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.
选择性5-羟色胺再摄取抑制剂（SSRI）比三环类药物更昂贵。报告表明，SSRI具有成本效益，因为它们耐受性更好，过量服用时更安全。
对所有比较SSRI和三环类抗抑郁药（TCA）的随机对照试验（RCT）、荟萃分析和成本效益研究进行系统评价。
没有一项RCT提供经济分析，大多数存在方法学问题，这会妨碍采用这种方法。荟萃分析表明，临床疗效相当，但接受SSRI治疗的患者退出RCT的人数略少。成本效益研究基于粗略的“建模”方法，高估了损耗率差异和治疗失败成本。由于自杀事件罕见，似乎无法评估其经济方面。
没有证据表明SSRI比TCA更具成本效益。只有在基于大型初级保健的RCT背景下进行前瞻性成本效益研究，这场争论才能得出结论。
