Pharmacoeconomic analysis of antidepressants for major depressive disorder in the United Kingdom

Objective: To estimate the cost effectiveness of different classes of antidepressants in the UK National Health Service. Design, patients and interventions: The use of the serotonin (5-hydroxyhyptamine; 5-HT) and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) venlafaxine was compared with that of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) in patients with major depressive disorder (MDD). A meta-analysis determined the clinical success rate, and a decision tree was constructed by interviewing general practitioners and psychiatrists. Adding pharmacological and nonpharmacological treatment costs, meta-analytic rates were applied to the decision tree to calculate the expected cost and outcome for each drug. Cost effectiveness was determined using a composite measure of outcome [symptom-free days (SFD)]. Main outcome measures and results: The meta-analysis included data from 44 studies on 4033 patients. The highest overall efficacy rate for outpatients with MDD was with venlafaxine use (73.7%), compared with 61.4% for SSRIs and 59.3% for TCAs. Treatment with venlafaxine yielded the lowest outpatient cost for a SFD (pound 10.53), compared with pound 13.23 for SSRIs and pound 15.52 for TCAs (1998 values). Conclusions: Using this economic model, venlafaxine appears to be a cost-effective treatment for outpatients with MDD in the UK.