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A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression
BACKGROUND: Depressed patients who initially fail to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. OBJECTIVES: The purpose of this study was to evaluate the effectiveness, cost, cost-effectiveness, and budget impact of second-line ph...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Academy of Managed Care Pharmacy
2007
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437458/ https://www.ncbi.nlm.nih.gov/pubmed/17874482 http://dx.doi.org/10.18553/jmcp.2007.13.s6-a.8 |
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author | Malone, Daniel C. |
author_facet | Malone, Daniel C. |
author_sort | Malone, Daniel C. |
collection | PubMed |
description | BACKGROUND: Depressed patients who initially fail to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. OBJECTIVES: The purpose of this study was to evaluate the effectiveness, cost, cost-effectiveness, and budget impact of second-line pharmacologic treatment for major depressive disorder (MDD). METHODS: A cost-effectiveness analysis was conducted to evaluate second line therapies (citalopram, escitalopram, fluoxetine, paroxetine, paroxetine controlled release [CR], sertraline, and venlafaxine extended release [XR]) for the treatment of depression. Effectiveness data were obtained from published clinical studies. The primary outcome was remission defined as a score of 7 or less on the Hamilton Rating Scale for Depression (HAM-D) or a score of 10 or less on the Montgomery-Asberg Depression Rating Scale (MADRS) depression rating scales. The wholesale acquisition cost (WAC) for medications and medical treatment costs for depression were included. The perspective was derived from a managed care organization (MCO) with 500,000 members, a 1.9% annual incidence of depression, and treatment duration of 6 months. Assumptions included: second-line treatment is not as effective as first-line treatment, WAC price reflects MCO costs, and side effects were identical. Sensitivity analyses were conducted to determine variables that influenced the results. RESULTS: Second-line remission rates were 20.4% for venlafaxine XR, 16.9% for sertraline, 16.4% for escitalopram, 15.1% for generic SSRIs (weighted average), and 13.6% for paroxetine CR. Pharmacy costs ranged from $163 for generic SSRIs to $319 for venlafaxine XR. Total cost per patient achieving remission was $14,275 for venlafaxine XR, followed by $16,100 for escitalopram. The incremental cost-effectiveness ratio (ICER) for venlafaxine XR compared with generic SSRIs was $2,073 per patient achieving remission, followed by escitalopram with an ICER of $3,566. The model was most sensitive to nonpharmacy costs. CONCLUSIONS: This analysis suggests that second-line treatment of depression with venlafaxine XR may result in more patients achieving remission, with an ICER that is favorable to other therapies. |
format | Online Article Text |
id | pubmed-10437458 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2007 |
publisher | Academy of Managed Care Pharmacy |
record_format | MEDLINE/PubMed |
spelling | pubmed-104374582023-08-21 A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression Malone, Daniel C. J Manag Care Pharm Cea BACKGROUND: Depressed patients who initially fail to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. OBJECTIVES: The purpose of this study was to evaluate the effectiveness, cost, cost-effectiveness, and budget impact of second-line pharmacologic treatment for major depressive disorder (MDD). METHODS: A cost-effectiveness analysis was conducted to evaluate second line therapies (citalopram, escitalopram, fluoxetine, paroxetine, paroxetine controlled release [CR], sertraline, and venlafaxine extended release [XR]) for the treatment of depression. Effectiveness data were obtained from published clinical studies. The primary outcome was remission defined as a score of 7 or less on the Hamilton Rating Scale for Depression (HAM-D) or a score of 10 or less on the Montgomery-Asberg Depression Rating Scale (MADRS) depression rating scales. The wholesale acquisition cost (WAC) for medications and medical treatment costs for depression were included. The perspective was derived from a managed care organization (MCO) with 500,000 members, a 1.9% annual incidence of depression, and treatment duration of 6 months. Assumptions included: second-line treatment is not as effective as first-line treatment, WAC price reflects MCO costs, and side effects were identical. Sensitivity analyses were conducted to determine variables that influenced the results. RESULTS: Second-line remission rates were 20.4% for venlafaxine XR, 16.9% for sertraline, 16.4% for escitalopram, 15.1% for generic SSRIs (weighted average), and 13.6% for paroxetine CR. Pharmacy costs ranged from $163 for generic SSRIs to $319 for venlafaxine XR. Total cost per patient achieving remission was $14,275 for venlafaxine XR, followed by $16,100 for escitalopram. The incremental cost-effectiveness ratio (ICER) for venlafaxine XR compared with generic SSRIs was $2,073 per patient achieving remission, followed by escitalopram with an ICER of $3,566. The model was most sensitive to nonpharmacy costs. CONCLUSIONS: This analysis suggests that second-line treatment of depression with venlafaxine XR may result in more patients achieving remission, with an ICER that is favorable to other therapies. Academy of Managed Care Pharmacy 2007-07 /pmc/articles/PMC10437458/ /pubmed/17874482 http://dx.doi.org/10.18553/jmcp.2007.13.s6-a.8 Text en Copyright © 2007, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited. |
spellingShingle | Cea Malone, Daniel C. A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression |
title | A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression |
title_full | A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression |
title_fullStr | A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression |
title_full_unstemmed | A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression |
title_short | A Budget-Impact and Cost-Effectiveness Model for Second-Line Treatment of Major Depression |
title_sort | budget-impact and cost-effectiveness model for second-line treatment of major depression |
topic | Cea |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437458/ https://www.ncbi.nlm.nih.gov/pubmed/17874482 http://dx.doi.org/10.18553/jmcp.2007.13.s6-a.8 |
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