Woods S W, Rizzo J A
Department of Psychiatry, Yale University School of Medicine, CT 06519, USA.
Br J Psychiatry. 1997 Mar;170:257-63. doi: 10.1192/bjp.170.3.257.
A recent simulation concluded that the serotonin-specific reuptake inhibitor (SSRI) paroxetine was more cost-effective than the tricyclic antidepressant (TCA) imipramine, despite substantially higher medication acquisition costs.
We replicated the previous model and revised key assumptions which drove the results. The revised model was subjected to sensitivity analysis.
Most scenarios in the revised model showed that the TCA is equally or more cost-effective than the SSRI. Model revision producing these results were changes in assumptions about switched treatment success rates, treatment length and initial treatment success. The revised model appears sensitive to drug acquisition and delivery costs and costs of treatment failure.
Based on the model, a policy of using TCAs as first-choice antidepressant treatment, with SSRIs reserved for those patients not doing well initially, appears more cost-effective than the reverse sequence. Given limitations in current knowledge about key parameters to include in a simulation model, large prospective random-assignment cost-effectiveness studies are needed.
最近的一项模拟研究得出结论，尽管血清素特异性再摄取抑制剂（SSRI）帕罗西汀的药物购置成本大幅高于三环类抗抑郁药（TCA）丙咪嗪，但前者更具成本效益。
我们复制了先前的模型，并修订了导致该结果的关键假设。对修订后的模型进行了敏感性分析。
修订后模型中的大多数情况表明，三环类抗抑郁药与血清素特异性再摄取抑制剂相比同样具有成本效益或更具成本效益。产生这些结果的模型修订包括对换药成功率、治疗时长和初始治疗成功率假设的改变。修订后的模型似乎对药物购置和给药成本以及治疗失败成本较为敏感。
基于该模型，将三环类抗抑郁药作为首选抗抑郁治疗药物，而将血清素特异性再摄取抑制剂留给那些初始治疗效果不佳的患者的策略，似乎比相反的顺序更具成本效益。鉴于当前在模拟模型中纳入关键参数的知识存在局限性，需要进行大型前瞻性随机分配成本效益研究。
