A budget-impact and cost-effectiveness model for second-line treatment of major depression

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Abstract

Background: Depressed patients who initially fall to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. Objective: 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. Conclusion: This analysis suggests that second-line treatment of depression with venlafaxlne XR may result in more patients achieving remission, with an ICER that is favorable to other therapies.

Original languageEnglish (US)
JournalJournal of managed care pharmacy : JMCP.
Volume13
Issue number6 SUPPL. A
StatePublished - Jul 2007

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Budgets
Cost effectiveness
Cost-Benefit Analysis
Citalopram
Depression
Paroxetine
Costs
Costs and Cost Analysis
Sertraline
Therapeutics
Managed Care Programs
Fluoxetine
Organizations
Serotonin Uptake Inhibitors
Major Depressive Disorder
Health Care Costs
Venlafaxine Hydrochloride
Incidence

Keywords

  • Antidepressants
  • Budget-impact model
  • Cost-effectiveness model
  • Major depressive disorder
  • Managed care
  • SNRI (serotonin norepinephrine reuptake Inhibitor)
  • SSRI
  • Venlafaxine extended release (XR)

ASJC Scopus subject areas

  • Pharmaceutical Science
  • Health Policy
  • Pharmacy

Cite this

@article{0fe9d02b7d62407689e0e9bccb111277,
title = "A budget-impact and cost-effectiveness model for second-line treatment of major depression",
abstract = "Background: Depressed patients who initially fall to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. Objective: 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. Conclusion: This analysis suggests that second-line treatment of depression with venlafaxlne XR may result in more patients achieving remission, with an ICER that is favorable to other therapies.",
keywords = "Antidepressants, Budget-impact model, Cost-effectiveness model, Major depressive disorder, Managed care, SNRI (serotonin norepinephrine reuptake Inhibitor), SSRI, Venlafaxine extended release (XR)",
author = "Malone, {Daniel C}",
year = "2007",
month = "7",
language = "English (US)",
volume = "13",
journal = "Journal of managed care & specialty pharmacy",
issn = "2376-0540",
publisher = "Academy of Managed Care Pharmacy (AMCP)",
number = "6 SUPPL. A",

}

TY - JOUR

T1 - A budget-impact and cost-effectiveness model for second-line treatment of major depression

AU - Malone, Daniel C

PY - 2007/7

Y1 - 2007/7

N2 - Background: Depressed patients who initially fall to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. Objective: 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. Conclusion: This analysis suggests that second-line treatment of depression with venlafaxlne XR may result in more patients achieving remission, with an ICER that is favorable to other therapies.

AB - Background: Depressed patients who initially fall to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. Objective: 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. Conclusion: This analysis suggests that second-line treatment of depression with venlafaxlne XR may result in more patients achieving remission, with an ICER that is favorable to other therapies.

KW - Antidepressants

KW - Budget-impact model

KW - Cost-effectiveness model

KW - Major depressive disorder

KW - Managed care

KW - SNRI (serotonin norepinephrine reuptake Inhibitor)

KW - SSRI

KW - Venlafaxine extended release (XR)

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VL - 13

JO - Journal of managed care & specialty pharmacy

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