ECONOMIC VALUATION OF AMITRIPTYLINE, DESIPRAMINE, NORTRIPTYLINE, AND SERTRALINE IN THE MANAGEMENT OF PATIENTS WITH DEPRESSION

The high prevalence of depression and its associated morbidity, mortality, and economic consequence to the health care delivery system and society mandate the selection of both efficacious and effective treatment, Recent pharmacotherapeutic advances in the treatment of patients with depression have included the development of selective serotonin re-uptake inhibitors (SSRIs), The present study was designed to contrast direct health service expenditures for the treatment of depression among patients enrolled in a health maintenance organization (HMO) and prescribed either the SSRI sertraline or one of three tricyclic antidepressants (TCAs) (amitriptyline, desipramine, or nortriptyline). Information regarding health service utilization was derived from the computer archive of a network-model HMO system serving 500,000 beneficiaries, A total of 823 HMO beneficiaries were found to satisfy the study selection criteria, Multivariate regression analysis was used to discern the incremental influence of selected demographic, clinical, financial, and provider characteristics on 1-year post-period expenditures (PPE) for health care, Analysis-of-variance procedures with Duncan's multiple-range test or chi square analyses revealed no significant baseline difference across antidepressant pharmacotherapy for age, 6-month prior-period expenditures for physician visits, psychiatric visits, laboratory tests, or psychiatric hospital services related to the treatment of depression (as defined via International Classification of Diseases, 9th revision, Clinical Modification or or Diagnostic and Statistical Manual of Mental Disorders, 4th edition code 296.2), or number of medications for concomitant disease state processes other than depression, Receipt of sertraline was associated with a significantly (P less than or equal to 0.05) higher rate of initial prescribing by psychiatrists and an increase in the number of prescriptions for antidepressant pharmacotherapy obtained (30-day supplies), Multivariate findings indicate that receipt of a TCA resulted in an increase in the use of physician visits ($101.65; P less than or equal to 0.05), psychiatric visits ($31.20; P = NS), laboratory tests ($1.82; P = NS), hospitalizations ($207.43; P less than or equal to 0.05), and psychiatric hospitalizations ($223.82; P less than or equal to 0.05) related to the treatment of depression, and a reduction in expenditures for antidepressant pharmacotherapy (-$398.31; P less than or equal to 0.05), for a total increase in health service utilization of $167.61 (P less than or equal to 0.05) 1 year post-initiation of antidepressant pharmacotherapy. These findings revealed there existed a 21% reduction in total health service expenditures with receipt of sertraline relative to a TCA.