Fluoxetine and imipramine: are there differences in cost-utility for depression in primary care?
نویسندگان
چکیده
RATIONALE Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses. OBJECTIVE To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care. METHODS A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner's usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out. RESULTS Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant. CONCLUSION Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.
منابع مشابه
Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: a six-month randomised study comparing fluoxetine to imipramine.
BACKGROUND Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice. METHODS A six-month randomised prosp...
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I n the article " Pharmacologic treatment of depression in late life " Alastair Flint gives a thorough and comprehensive review of the treatment of depression. He mentions that to his knowledge, " only 1 trial has compared an SSRI [selective serotonin reuptake inhibitor] (sertra-line) with a secondary amine TCA [tricyclic antidepressant] (nortripty-line), and both drugs were equally well tolera...
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عنوان ژورنال:
- Journal of evaluation in clinical practice
دوره 15 1 شماره
صفحات -
تاریخ انتشار 2009