Cargando…

The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model

PURPOSE: There is variation in the safety profile of antidepressants. Rates of adverse events along with the costs of treating them can be an important factor influencing the choice of depression treatment. This study sought to estimate the comparative safety of commonly prescribed antidepressants,...

Descripción completa

Detalles Bibliográficos
Autores principales: Kearns, Benjamin, Cooper, Katy, Orr, Martin, Essat, Munira, Hamilton, Jean, Cantrell, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188369/
https://www.ncbi.nlm.nih.gov/pubmed/35698594
http://dx.doi.org/10.2147/NDT.S356414
_version_ 1784725357222428672
author Kearns, Benjamin
Cooper, Katy
Orr, Martin
Essat, Munira
Hamilton, Jean
Cantrell, Anna
author_facet Kearns, Benjamin
Cooper, Katy
Orr, Martin
Essat, Munira
Hamilton, Jean
Cantrell, Anna
author_sort Kearns, Benjamin
collection PubMed
description PURPOSE: There is variation in the safety profile of antidepressants. Rates of adverse events along with the costs of treating them can be an important factor influencing the choice of depression treatment. This study sought to estimate the comparative safety of commonly prescribed antidepressants, and how the costs of treating these varied across European countries. METHODS: A systematic literature review was conducted (in Medline, Embase, PsycINFO and CENTRAL) to identify placebo-controlled trials reporting rates of at least one type of sexual dysfunction, weight change, insomnia, anxiety, and anhedonia. Eight antidepressants were considered: duloxetine, escitalopram, fluoxetine, paroxetine, sertraline, trazodone, venlafaxine, and vortioxetine. This evidence was synthesised via Bayesian random effects network meta-analyses to provide comparative estimates of safety. A systematic search identified country-specific costs of managing depression and adverse events of antidepressants. Evidence on costs and safety was combined in an economic model to provide country-specific costs for Bulgaria, the Czech Republic, Greece, Hungary, Italy, Romania, Slovakia, Portugal, and Poland. RESULTS: Trazodone had the lowest rates of both insomnia (odds ratio 0.66, 95% credible interval 0.31 to 1.38) and anxiety (0.13, <0.01 to 1.80). All antidepressants were associated with increased rates of sexual dysfunction relative to placebo. Weight change was largest for fluoxetine (kg change −1.01, −1.40 to −0.60) and sertraline (−1.00, −1.36 to −0.65), although heterogeneity was extreme for this outcome. No evidence was identified for anhedonia. Total costs were lowest for trazodone in all nine of the countries evaluated. This was primarily due to reduced rates of treatment discontinuation. CONCLUSION: Trazodone generally had the best safety profile of the antidepressants evaluated. This led to healthcare costs being lowest for trazodone in all nine European countries, emphasising the importance of considering rates of adverse events when choosing a pharmacological treatment to treat symptoms of depression.
format Online
Article
Text
id pubmed-9188369
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Dove
record_format MEDLINE/PubMed
spelling pubmed-91883692022-06-12 The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model Kearns, Benjamin Cooper, Katy Orr, Martin Essat, Munira Hamilton, Jean Cantrell, Anna Neuropsychiatr Dis Treat Original Research PURPOSE: There is variation in the safety profile of antidepressants. Rates of adverse events along with the costs of treating them can be an important factor influencing the choice of depression treatment. This study sought to estimate the comparative safety of commonly prescribed antidepressants, and how the costs of treating these varied across European countries. METHODS: A systematic literature review was conducted (in Medline, Embase, PsycINFO and CENTRAL) to identify placebo-controlled trials reporting rates of at least one type of sexual dysfunction, weight change, insomnia, anxiety, and anhedonia. Eight antidepressants were considered: duloxetine, escitalopram, fluoxetine, paroxetine, sertraline, trazodone, venlafaxine, and vortioxetine. This evidence was synthesised via Bayesian random effects network meta-analyses to provide comparative estimates of safety. A systematic search identified country-specific costs of managing depression and adverse events of antidepressants. Evidence on costs and safety was combined in an economic model to provide country-specific costs for Bulgaria, the Czech Republic, Greece, Hungary, Italy, Romania, Slovakia, Portugal, and Poland. RESULTS: Trazodone had the lowest rates of both insomnia (odds ratio 0.66, 95% credible interval 0.31 to 1.38) and anxiety (0.13, <0.01 to 1.80). All antidepressants were associated with increased rates of sexual dysfunction relative to placebo. Weight change was largest for fluoxetine (kg change −1.01, −1.40 to −0.60) and sertraline (−1.00, −1.36 to −0.65), although heterogeneity was extreme for this outcome. No evidence was identified for anhedonia. Total costs were lowest for trazodone in all nine of the countries evaluated. This was primarily due to reduced rates of treatment discontinuation. CONCLUSION: Trazodone generally had the best safety profile of the antidepressants evaluated. This led to healthcare costs being lowest for trazodone in all nine European countries, emphasising the importance of considering rates of adverse events when choosing a pharmacological treatment to treat symptoms of depression. Dove 2022-06-07 /pmc/articles/PMC9188369/ /pubmed/35698594 http://dx.doi.org/10.2147/NDT.S356414 Text en © 2022 Kearns et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Kearns, Benjamin
Cooper, Katy
Orr, Martin
Essat, Munira
Hamilton, Jean
Cantrell, Anna
The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model
title The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model
title_full The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model
title_fullStr The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model
title_full_unstemmed The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model
title_short The Incidence and Costs of Adverse Events Associated with Antidepressants: Results from a Systematic Review, Network Meta-Analysis and Multi-Country Economic Model
title_sort incidence and costs of adverse events associated with antidepressants: results from a systematic review, network meta-analysis and multi-country economic model
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188369/
https://www.ncbi.nlm.nih.gov/pubmed/35698594
http://dx.doi.org/10.2147/NDT.S356414
work_keys_str_mv AT kearnsbenjamin theincidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT cooperkaty theincidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT orrmartin theincidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT essatmunira theincidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT hamiltonjean theincidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT cantrellanna theincidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT kearnsbenjamin incidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT cooperkaty incidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT orrmartin incidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT essatmunira incidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT hamiltonjean incidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel
AT cantrellanna incidenceandcostsofadverseeventsassociatedwithantidepressantsresultsfromasystematicreviewnetworkmetaanalysisandmulticountryeconomicmodel