Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-26T16:55:50.584Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of the cost-effectiveness of milnacipran (a SNRI) with TCAs and SSRIs: a modeling approach

Published online by Cambridge University Press:  16 April 2020

R Dardennes ,
G Berdeaux ,
A Lafuma  and
F Fagnani
R Dardennes
Affiliation:
Université René-Descartes Paris V, Hôpital Sainte-Anne, 100, rue de la Santé, 75014 Paris
G Berdeaux
Affiliation:
Pierre Fabre Médicament SA, 45, place Abel-Gance, 92100 Boulogne-Billancourt cedex
A Lafuma
Affiliation:
Cemka, 43, boulevard Maréchal-Joffre, 92340 Bourgla-Reine, France
F Fagnani
Affiliation:
Cemka, 43, boulevard Maréchal-Joffre, 92340 Bourgla-Reine, France
Get access

Summary

A simulation model based on the theory of clinical decision analysis was used to compare outcomes and costs when treating patients with major depressive episodes using either a selective serotonin re-uptake inhibitor (SSRI) or a tricyclic antidepressant (TCA), in comparison with milnacipran (a serotonin), and a norepinephrine re-uptake inhibitor (SNRI). The clinical data used were taken from published meta-analyses. This analysis supports: (1) a comparable efficacy of milnacipran and TCA with a better tolerance; and, (2) an advantage of milnacipran over SSRI for efficacy with a comparable tolerance. Based on these findings, a decision tree was constructed with the assistance of a panel of psychiatrists in order to provide a model of usual clinical practice. Estimates not available from clinical studies were obtained either from literature analysis or from the panel.

Economic appraisal was performed according to the viewpoint of the French national sickness fund (sécurité sociale), and expenditure assessment was limited to direct costs (hospitalizations, antidepressant medications, visits, and laboratory tests). The results suggest that milnacipran is a cost-effective alternative: the expected cost of treatment per depressive episode is lower than either a French representative panel of TCAs (a saving of 288 FF), or SSRIs (a savings of 961 FF). The expected length of clinical remission is slightly higher than comparators. The robustness of these findings was supported by sensitivity analyses.

Keywords

cost and consequencesdecision analysisdepressionpharmacoeconomicsselective-serotonin re-uptake inhibitorserotonin and norepinephrine re-uptake inhibitortricyclic antidepressant
Type
Original Articles
Information
European Psychiatry , Volume 14 , Issue 3 , June 1999 , pp. 152 - 162
Copyright
Copyright © European Psychiatric Association 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aberg-Wistedt, AComparison between zimelidine and desipramine in endogenous depression: a cross-over study. Acta Psychiatr Scand 1982 ; 66 : 129–138.10.1111/j.1600-0447.1982.tb00921.xCrossRefGoogle ScholarPubMed
Agence du Medicament, Fiches de Transparence In: Agence du médicament, CFES 1994 Paris: Agence du médicament 187–187.Google Scholar
Anderson, IM, Tomenson, BMThe efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants. J Psychopharmacology 1994 ; 8 : 238–249.CrossRefGoogle ScholarPubMed
Angst, JHow recurrent and predictable is depressive illness? In: Montgomery, S, Rouillon, F eds. Perspectives in psychiatry, vol 3 Long-term treatment of depression 1992 Toronto: John and Willey & Sons 114114.Google Scholar
Benkert, O, Grunder, G, Wetzel, H, Hackett, DA randomized, double blind comparison of a rapidly escalating dose of venlafaxine and imipramine in inpatients with major depression and melancholia. J Psychiatr Res 1996 ; 30 : 441–451.CrossRefGoogle ScholarPubMed
Bentkover, JD, Feighner, JPCost analysis of paroxetine versus imipramine in major depression. Pharmacoeconomics 1995 ; 8 : 223–232.CrossRefGoogle ScholarPubMed
Bland, RC, Newman, SC, Orn, HPeriod prevalence of psychiatric disorder in Edmonton. Acta Psychiatr Scand 1988 ; 77 : 33–42.CrossRefGoogle Scholar
Bland, RC, Orn, H, Newman, SCLifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand 1988 ; 77 : 24–32.CrossRefGoogle Scholar
Blazzer, DG, Kessler, RC, Gonagle, MC, Swartz, KAThe prevalence and distribution of major depression in a national community sample: the national comorbidity survey. Am J Psychiatry 1994 ; 154 : 979–986.Google Scholar
Clerc, GE, Ruimy, P, Verdeau-Palles, JA double blind comparison of venlafaxine and fluoxetine in patients hospitalized for major depression and melancholia The venlafaxine inpatient study group. Int Clin Psychopharmacol 1994 ; 9 : 130–143.CrossRefGoogle ScholarPubMed
Diereck, M, Ravizza, L, Realini, R, Martin, AA double blind comparison of venlafaxine and fluoxetine for the treatment of major depression in outpatients. Prog Neuropsychopharmacol Biol Psychiatry 1996 ; 20 : 57–71.Google Scholar
Donoghue, JM, Tylee, AThe treatment of depression: prescribing patterns of antidepressants in primary care in the UK. Br J Psychiatry 1996 ; 168 : 164–168.CrossRefGoogle ScholarPubMed
Doogan, DP, Caillard, VSertraline in the prevention of depression. Br J Psychiatry 1992 ; 160 : 217–222.10.1192/bjp.160.2.217CrossRefGoogle ScholarPubMed
Einarson, TR, Srikian, S, Sweeney, S, Doyle, JA model to evaluate the cost-effectiveness of oral therapies in the management of patients with major depressive disorders. Clin Therapeutics 1995 ; 17 : 136–153.CrossRefGoogle Scholar
Emrich, H, Berger, M, Riemann, D, von Zerssen, DSerotonin re-uptake inhibition versus norepinephrine re-uptake inhibition: a double-blind differential therapeutic study with fluvoxamine and oxaprotiline in endogenous and neurotic depressives. Pharmacopsychiatrica 1987 ; 20 : 60–63.CrossRefGoogle Scholar
Favarelli, C, Ambonetti, A, Pallanti, S, Pazzagli, ADepressive relapses and incomplete recovery from index episode. Am J Psychiatry 1986 ; 143 : 888–891.Google Scholar
Guidelines and recommendations for French pharmacoeconomic studies Collège des économiste de la santé April 1997 Paris: La lettre du collègeGoogle Scholar
Johnson, DAWA study of the use of antidepressant medication in general practice. Br J Psychiatry 1974 ; 125 : 186–192.CrossRefGoogle ScholarPubMed
Johnson, DAWTreatment of depression in general practice. Br Med J 1973 ; 2 : 18–20.CrossRefGoogle ScholarPubMed
Jonsson, B, Bebbington, PEWhat price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. Br J Psychiatry 1994 ; 164 : 665–673.CrossRefGoogle ScholarPubMed
Katon, W, von Korff, M, Lin, E, Bush, T, Omel, JAdequacy and duration of antidepressant treatment in primary care. Med Care 1992 ; 30 : 67–76.CrossRefGoogle ScholarPubMed
Kay, DWK, Garside, RF, Poy, JRBearnish P Endogenous and neurotic syndromes of depression: a 5 to 7 years follow-up of 104 cases. Br J Psychiatry 1969 ; 115 : 389–399.CrossRefGoogle Scholar
Keller, MB, Klerman, GL, Lavori, PW, Fawcett, JA, Coryell, W, Endicott, JTreatment received by depressed patients. JAMA 1982 ; 248 : 1848–1855.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Klerman, GL, Andreasen, NC, Endicott, J, Coryell, WLow levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Arch Gen Psychiatry 1986 ; 43 : 458–466.CrossRefGoogle ScholarPubMed
Kotin, J, Post, RM, Goodwin, FKDrug treatment of depressed patients referred for hospitalization. Am J Psychiatry 1973 ; 130 : 1139–1141.CrossRefGoogle ScholarPubMed
Kovess, V, Gysens, S, Chanoit, PFUne enqu te de santé mentale: l'enquête de santé des Franciliens. Ann Med Psychol 1993 ; 151 : 624–628.Google Scholar
Lapierre, Y, Bentkover, J, Schainbaum, S, Manners, SDirect cost of depression: analysis of treatment costs of paroxetine versus imipramine in Canada. Can J Psychiatry 1995 ; 40 : 370–377.CrossRefGoogle ScholarPubMed
LePape, A, Lecomte, TAspects socio-économiques de la dépression 1996 Paris: CREDES 8383.Google Scholar
LePen, C, Levy, E, Ravily, V, Beuzen, JN, Meurgey, FThe cost of treatment dropout in depression A cost-benefit analysis of fluoxetine vs tricyclics. J Affect Disord 1994 31 1–18.CrossRefGoogle Scholar
Lecomte, TAspects socio-économiques de la dépression. Ann Med Interne 1989 ; 140 : 687–690.Google Scholar
Lepine, JP, Lellouch, J, Lovell, A, Téhérani, M, Ha, C, Verdier-Taillefer, MHAnxiety and depressive disorders in a French population: methodology and preliminary results. Psychiat Psychobiol 1989 ; 4 : 267–274.CrossRefGoogle Scholar
Lingjaerde, O, Bratfos, O, Bratlid, T, Hang, JA double-blind comparison of zimelidine and desipramine in endogenous depression. Acta Psychiatr Scand 1983 ; 68 : 22–30.CrossRefGoogle ScholarPubMed
Maj, M, Veltro, F, Pirozzi, R, Lobrace, S, Magliano, LPatterns of recurrence of illness after recovery from an episode of major depression: a prospective study. Am J Psychiatry 1992 ; 149 : 795–800.Google Scholar
Main Economic Indicators, Organisation de coopération et de développement economique 1996 Paris: OECDGoogle Scholar
Ministère des Affaires Sociales et de l'Intégration Les soins hospitaliers en France Clientèle, pathologies traîtées en cours séjour 1992 Paris: la documentation Française 247247.Google Scholar
Montgomery, SA, Dufour, H, Brion, S, Gailledreau, J, Laqueille, X, Ferrey, GThe prophylactic efficacy of Fluoxetine in unipolar depression. Br J Psychiatry 153 Suppl 3 1988 69–76.CrossRefGoogle Scholar
Nomenclature générale des actes professionnels Paris: Union des Caisses Nationales de Sécurité Sociale; 1996 p 106Google Scholar
Nuijten, MJC, Hardens, M, Souetre, EA markov process analysis comparing the cost-effectiveness of maintenance therapy with citalopram versus standard therapy in major depression. Pharmacoeconomics 1995 ; 8 : 159–168.CrossRefGoogle ScholarPubMed
Nystrom, C, Hallstrom, TComparison between serotonin and norepinephrine re-uptake blocker in the treatment of depressed outpatients: a crossover study. Acta Psychiatr Scand 1987 ; 75 : 377–382.CrossRefGoogle Scholar
Nystrom, C, Hallstrom, TDouble-blind comparison between serotonin and norepinephrine re-uptake blocker in the treatment of depressed patients: clinical aspects. Acta Psychiatr Scand 1985 ; 72 : 6–15.CrossRefGoogle Scholar
Perry, PJPharmacotherapy for major depression with melancolic features: relative efficacy of tricyclic versus selective serotonin re-uptake inhibitors antidepressants. J Affect Disord 1996 ; 39 : 1–6.CrossRefGoogle Scholar
Puech, A, Montgomery, S, Prost, JF, Solles, A, Briley, MMilnacipran, a new serotonin and noradrenaline re-uptake inhibitor: an overview of its antidepressant activity and clinical tolerability. Int Clin Psychopharmacol 1997 ; 12 : 99–108.CrossRefGoogle Scholar
Revicki, DA, Brown, RE, Palmer, W, Bakish, D, Rosser, WW, Anton, SF, Feeny, DModelling the cost-effectiveness of antidepressant treatment in primary care. Pharmacoeconomics 1995 ; 8 : 524–540.CrossRefGoogle ScholarPubMed
Rosholm, JU, Hallas, J, Gram, LFOutpatient utilization of antidepressants: a prescription database analysis. J Affect Disord 1993 ; 27 : 21–28.CrossRefGoogle ScholarPubMed
Rouillon, F, Blachier, C, Dreyfus, JP, Bouhassira, M, Allicar, MPÉtude pharmaco-épidémiologique de la consommation des antidépresseurs en population générale. L'Encéphale 1996 ; Suppl I : 39–48.Google Scholar
Simon, GE, Vonkorff, M, Wagner, EH, Barlow, WPatterns of antidepressant use in community practice. Gen Hosp Psychiatry 1993 ; 15 : 399–408.CrossRefGoogle ScholarPubMed
Souêtre, E, Lozet, H, Martin, P, Lecanu, JP, Gauthier, JM, Beuzen, JNArrêt de travail et dépression Impact de la fluoxétine. Thérapie 1993 ; 45 : 81–88.Google Scholar
Stoudemire, A, Frank, R, Hedemark, N, Kamlet, M, Blazer, DThe economic burden of depression. Gen Hosp Psychiatry 1986 ; 8 : 387–394.CrossRefGoogle ScholarPubMed
Thompson, C, Thompson, CMThe prescription of antidepressants in general practice I: a critical review. Hum Psychopharmacol 1989 ; 4 : 91–102.CrossRefGoogle Scholar
Thompson, C, Thompson, CMPrescribing of antidepressants in general practice II: a placebo controlled trial of low dose dothiepin. Hum Psychopharmacol 1989 ; 4 : 191–204.CrossRefGoogle Scholar
Vidal, Editions du Vidal 1996 Paris: Union des Caisses Nationales de Sécurité Sociale 1871–1871.Google Scholar
Wells, KB, Katon, W, Rogers, B, Camp, PUse of minor tranquilizers and antidepressant medications by depressed outpatients: results from the medical outcomes study. Am J Psychiatry 1994 ; 151 : 694–700.Google ScholarPubMed
Weinstein, MC, Fineberg, HVClinical Decision Analysis 1992 Philadelphia: SaundersGoogle Scholar
Winokur, G, Coryell, W, Endicott, J, Akiskal, H, Keller, M, Maser, JDFamilial depression versus depression identified in a control group: are they the same?. Psychol M 1995 ; 25 : 797–806.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.