Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T21:51:58.447Z Has data issue: false hasContentIssue false
  • English
  • Français

La valutazione dei costi del trattamento farmacologico nella depressione. Una revisione critica della letteratura

Published online by Cambridge University Press:  07 August 2014

Cesario Bellantuono  and
Matteo Balestrieri
Cesario Bellantuono*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Matteo Balestrieri
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona Istituto di Clinica Psichiatrica, Università di Catania, Catania
*
Indirizzo per la corrispondenza: Prof. C. Bellantuono, Servizio di Psicologia Medica, Ospedale Policlinico, 37134 Verona. Fax (+39) 045-585.871.
Get access Rights & Permissions [Opens in a new window]

Summary

Aims -. To review the factors which are relevant for a correct evaluation of the costs of antidepressant drug treatment and to report the results of the studies on the efficacy, tollerability and costs of the most utilized antidepressants (tricyclics and SSRI). Methods - We reviewed the international literature concerning both with comparative studies on efficacy, tollerability and safety of tricyclics and SSRI and with studies of pharmacoeconomics that have focused on the costs of depression and of different antidepressant treatments. Results - Depression involves high costs, especially if indirect costs are considered. Comparative studies indicate a substantial equivalence of efficacy between tricyclics and SSRI, but a better tolerability of the latters. The few studies of pharmacoeconomics that have evaluated different antidepressant drugs indicate that a treatment with SSRI involves lower costs as compared with tricyclics. These results are due to the higher indirect costs (compliance, drop-out for side-effects, work loss, etc.) of tricyclics. Conclusions - A correct economic evaluation of an antidepressant drug treatment should consider both direct and indirect costs. Available studies indicate that SSRI involves lower costs as compared with tricyclics; however in order to confirm these results more studies of pharmacoeconomics are needed with experimental designes (longitudinal studies) taking into account the outcome of patients treated in routine clinical practice.

Keywords

economic evaluationantidepressantsdepressionanalisi dei costiantidepressividepressione
Type
Articoli
Information
Epidemiology and Psychiatric Sciences , Volume 4 , Issue 1 , Gennaio-Aprile 1995 , pp. 51 - 66
Copyright
Copyright © Cambridge University Press 1995

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

BIBLIOGRAFIA

Albanesi, G. (1991). La Terapia Antidepressiva. Masson: Milano.Google Scholar
Altamura, A.C., Montgomery, S.A. & Wernicke, J.F. (1988). The evidence for 20 mg a day of fluoxetine as the optimal dose in the treatment of depression. British Journal of Psychiatry 153, 109–112.CrossRefGoogle Scholar
American Psychiatric Association (1993). Practice Guideline for Major Depressive Disorder in Adults. American Journal of Psychiatry 150 (suppl. 4), 1–26.CrossRefGoogle Scholar
Angst, J. (1992). The epidemiology of depression. Psychopharmacology 106 (suppl.), 71–74.CrossRefGoogle ScholarPubMed
Balestrieri, M. & Zimmermann-Tansella, Ch. (1993). Placebo, effetto placebo e fattori aspecifici nel trattamento farmacologico e in psicoterapia. In Gli Psicofarmaci nelta Pratica Terapeutica (ed. Bellantuono, C. e Tansella, M.), pp. 101–148. Il Pensiero Scientifico Editore: Roma.Google Scholar
Balestrieri, M., Bragagnoli, N. & Bellantuono, C. (1991). Antidepressant drug prescribing in general practice: a 6-year study. Journal of Affective Disorders 21, 45–55.CrossRefGoogle ScholarPubMed
Balestrieri, M., Paltrinieri, E. & Bellantuono, C. (1992). Who prescribes antidepressant drugs? A survey of a sample of pharmacies in Verona, Italy. Human Psychopharmacology 7, 193–198.CrossRefGoogle Scholar
Beaumont, G. (1989). The toxicity of antidepressants. British Journal of Psychiatry 154, 454–458.CrossRefGoogle ScholarPubMed
Bech, P., Dunbar, G.C. & Stoker, M.J. (1993). The challenge of measuring quality of life in psychiatric patients. In Health Economics of Depression (ed. Jönsson, B. and Rosenbaum, J.), pp. 111–128. John Wiley & Sons: Chichester.Google Scholar
Bellantuono, C. & Tansella, M. (ed.) (1989). Epidemiologia e Trattamento dei Disturbi Psichiatrici nella Medicina di Base. Quaderni Italiani di Psichiatria (Numero Monografico), pp. 197–263, Vol. 8, n.3.Google Scholar
Bellantuono, C., Balestrieri, M. & Martini, N. (1989). Solfo-adenosil-metionina (SAMe): farmaco antidepressivo? Giornale Italiano di Farmacia Clinica 3, No. 2, 77–80.Google Scholar
Bellantuono, C., Balestrieri, M. & Nicolaou, S. (1993). Gli psicofarmaci nella terapia delle sindromi depressive. In Gli Psicofarmaci nella Pratica Terapeutica (ed. Bellantuono, C. e Tansella, M.), pp. 321–398. Il Pensiero Scientifico Editore: Roma.Google Scholar
Bellantuono, C., Slomp, D. & Vampini, C. (1994). Amineptina: considerazioni su benefici e rischi. Ricerca & Pratica 60, 180–186.Google Scholar
Beuzen, J.N., Ravily, V.F., Souetre, E.J. & Thomander, L. (1993). Impact of fluoxetine on work loss in depression. International Clinical Psychopharmacology 8, 319–321.CrossRefGoogle ScholarPubMed
Blue, I. & Harpham, T. (1994). The World Bank World Development Report 1993: Investing in Health. Reveals the burden of common mental disorders, but ignores its implications. British Journal of Psychiatry 165, 9–12.CrossRefGoogle ScholarPubMed
Boyer, W.F. & Blumhardt, C. (1992). The safety profile of paroxetine. Journal of Clinical Psychiatry 53, 61–66.Google ScholarPubMed
Bressler, R. & Katz, M.D. (1993). Drug therapy for geriatric depression. Drug & Aging 3, 195–219.CrossRefGoogle ScholarPubMed
British Medical Journal (1993). Correspondence on: Effective and acceptable treatment for depression. British Medical Journal 306, 1124–1126.CrossRefGoogle Scholar
Cassidy, S. & Henry, J.A. (1987). Fatal toxicity of antidepressant drugs in overdose. British Medical Journal 295, 1021–1024.CrossRefGoogle ScholarPubMed
Cooper, G.L. (1988). The safety of fluoxetine. An update. British Journal of Psychiatry 153 (suppl. 3), 77–86.CrossRefGoogle Scholar
Currie, D.J., Fairweather, D.B. & Hindmarch, I. (1993). Social aspects of treating depression. In Health Economics of Depression (ed. Jönsson, B. and Rosenbaum, J.), pp. 129–140. John Wiley & Sons: Chichester.Google Scholar
de Jonghe, F. & Swinkels, J.A. (1992). The safety of antidepressants. Drugs (suppl. 2), 40–47.Google Scholar
Donaldson, C. (1990). Willingness to pay for publicly provided goods: a possible measure of benefit. Journal of Health Economics 9, 103–118.CrossRefGoogle ScholarPubMed
Dornseif, B.E., Dunlop, S.R, Potvin, J.H. (1989). Effects of dose escalation after low-dose fluoxetine therapy. Psychopharmacology Bulletin 25, 71–79.Google ScholarPubMed
Dunbar, G.C. & Stoker, M.J. (1992). The development of a questionnaire to measure quality of life in psychiatric patients. British Journal of Medical Economy 4, 63–73.Google Scholar
Dunbar, G.C., Cohn, J.B., Fabre, L.F., Feighner, J.P., Fieve, R.R. & Mendels, J. (1991). A comparison of paroxetine, imipramine and placebo in depressed outpatients. British Journal of Psychiatry 150, 394–398.CrossRefGoogle Scholar
Dunner, D.L. & Dunbar, G.C. (1992). Optimal dose regimen for paroxetine. Journal of Clinical Psychiatry 53 (suppl. 2), 2126.Google ScholarPubMed
Eccleston, D. (ed.) (1993). The economic evaluation of antidepressant drug therapy. British Journal of Psychiatry 163 (suppl. 20), 5–42.CrossRefGoogle Scholar
Elkin, I., Shea, T., Watkins, J.T., et al. (1989). National Institute of Mental Health treatment of depression collaborative research program. Archives of General Psychiatry 46, 971–983.CrossRefGoogle ScholarPubMed
Enemark, B. (1993). The importance of ECG monitoring in antidepressant treatment. Nordic Journal of Psychiatry 41 (suppl. 30), 57–66.CrossRefGoogle Scholar
Euroqol Group (1990). Euroqol: a new facility for the measurement of health related quality of life. Health Policy 16, 199–208.CrossRefGoogle Scholar
Faravelli, C., Paterniti, S. & Taberna, A. (1994). Ansia e depressione nella popolazione generale Epidemiologia e Psichiatria Sociale 3, 19–26.CrossRefGoogle Scholar
Fava, M., Rosenbaum, J.F. & Cohen, L. (1992). High-dose fluoxetine in the treatment of depressed patients not responsive to a standard dose of fluoxetine. Journal of Affective Disorders 25, 229–234.CrossRefGoogle Scholar
Fawcett, J. (1993). The morbidity and mortality of clinical depression. International Clinical Psychopharmacology 8, 217–220.CrossRefGoogle ScholarPubMed
Goldberg, D. (1993). Syndromal subgroups of depression. International Clinical Psychopharmacology 7, 203–204.CrossRefGoogle ScholarPubMed
Greenberg, P.E., Stiglin, L.E., Finkelstein, S.L. & Berndt, E.R. (1993). The economic burden of depression in 1990. Journal of Clinical Psychiatry 54, 405–418.Google ScholarPubMed
Hale, A.S. (1994). The importance of accidents in evaluating the cost of SSRIs: a review. International Clinical Psychopharmacology 9, 195–201.CrossRefGoogle ScholarPubMed
Hatziandreu, E.J., Brown, R.E., Revicki, D.A., Turner, R., Martindale, J., Levine, S. & Siegel, J.E. (1994). Cost utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepine. PharmacoEconomics 5, 249–264.CrossRefGoogle Scholar
Henry, J.A. & Antao, C.A. (1992). Suicide and fatal antidepressant poisoning. European Journal of Medicine 1, 343–348.Google ScholarPubMed
Jenner, P.N. (1992). Paroxetine: an overview of dosage, tolerability and safety. International Clinical Psychopharmacology 6 (suppl. 4), 69–80CrossRefGoogle ScholarPubMed
Johnson, D.A.W. (1986). Non-compliance with antidepressant therapy: an underestimated problem. Internal Medicine (suppl. 11), 14–17.Google ScholarPubMed
Johnson, J., Weissman, M.N. & Klerman, G.L. (1992). Service utilization and social morbidity associated with depressive symptoms in the community. Journal of the American Medical Association 267, 1478–1483.CrossRefGoogle ScholarPubMed
Jönsson, B. & Bebbington, P. (1993). Economic studies of the treatment of depressive illness. In Health Economics of Depression (ed. Jönsson, B. and Rosenbaum, J.), pp. 35–48. John Wiley & Sons: Chichester.Google Scholar
Jönsson, B. & Rosenbaum, J. (ed.) (1993). Health Economics of Depression. John Wiley & Sons: Chichester.Google Scholar
Jönsson, B. & Bebbington, P.E. (1994). What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. British Journal of Psychiatry 164, 665–673.CrossRefGoogle ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Bush, T. & Ormel, J. (1992). Adequacy and duration of antidepressant treatment in primary care. Medical Care 30, 67–76.CrossRefGoogle ScholarPubMed
Kind, P. & Sorensen, J. (1993). The costs of depression. International Clinical Psychopharmacology 7, 191–195.CrossRefGoogle ScholarPubMed
Le Pen, C., Levy, E., Ravily, V., Beuzen, J.N. & Meurgey, F. (1994). The cost of treatment dropout in depression. A cost-benefit analysis of fluoxetine vs. tricyclics. Journal of Affective Disorders 31, 1–18.CrossRefGoogle ScholarPubMed
Maynard, A. (1991). Developing the health care market. Economic Journal 101, 1277–1286.CrossRefGoogle Scholar
Maynard, A. (1993). Cost management: the economist's viewpoint. British Journal of Psychiatry 163 (suppl. 20), 7–13.CrossRefGoogle Scholar
McCombs, J.S., Nichol, M.B., Stimmel, G.L., Sclar, D.A., Beasley, C.M. & Gross, L.S. (1990). The cost of antidepressant drug therapy failure. A study of antidepressant use patterns in a medical population. Journal of Clinical Psychiatry 51 (suppl. 6), 60–69.Google Scholar
McGuire, A. & Drummond, M. (1993). Economic evaluation in health care: an introduction for psychiatrists. Social Psychiatry and Psychiatric Epidemiology 28, 211–217.CrossRefGoogle ScholarPubMed
MECOSAN (1994). Il Nuovo Prontuario Farmacoterapeutico: spunti di riflessione a partire dai farmaci antidepressivi. Management e Economia Sanitaria 9, 5–34.Google Scholar
Miselli, M. (ed.) (1993). Prontuario dei Costi delle Terapie Farmacologiche. Farmacie Comunali Riunite: Reggio Emilia.Google Scholar
Montgomery, S.A. (1992). Suicide antidepressants. Drugs 43 (suppl. 2), 24–31.CrossRefGoogle ScholarPubMed
Montgomery, S.A., Bebbington, P. & Cowen, P. (1992). Guidelines for treating depressive illness with antidepressants. A statement from the British Association for Psychopharmacology. Journal of Psychopharmacology 7, 19–23.CrossRefGoogle Scholar
Montgomery, S.A., Henry, J., McDonald, G., Dinan, T., Lader, M., Hindmarch, I., Clare, A. & Nutt, D. (1994). Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. International Clinical Psychopharmacology 9, 47–53.CrossRefGoogle ScholarPubMed
Murdoch, D. & McTavish, D. (1992). Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder. Drugs 44, 604–624.CrossRefGoogle ScholarPubMed
Pande, A.C. & Sayler, M.E. (1993). Adverse events and treatment discontinuation in fluoxetine clinical trials. International Clinical Psychopharmacology 8, 267–269.CrossRefGoogle ScholarPubMed
Paykel, E.S. & Priest, R.G. (1992). Recognition and management of depression in general practice. Consensus statement. British Medical Journal 305, 1198–1202.CrossRefGoogle ScholarPubMed
Piccinelli, M., Pini, S., Bonizzato, P., Paltrinieri, E., Saltini, A., Scantamburlo, L., Bellantuono, C. & Tansella, M. (1995). Centre Report: Verona. In Mental Illness in Primary Care. An International Study (ed. Sartorius, N. and Üstün, T.B.). John Wiley and Sons: New York (in press).Google Scholar
Placidi, G.F., Marazziti, D., Macchi, E. & Dell'Osso, L. (1993). Antidepressivi. In Trattato Italiano di Psichiatria (ed. Cassano, G.B., D'Errico, A., Pancheri, P., et al.), pp. 2459–2483. Masson: Milano.Google Scholar
Sacchetti, E., Vita, A., Guarneri, L., et al. (1991). The effectiveness of fluoxetine, clomipramine, nortriptyline and desipramine in major depressives with suicidal behaviour: preliminary findings. In Serotonin-Related Psychiatric Syndromes: Clinical and Therapeutics Links (ed. Cassano, G.B. and Akiskal, H.S.). International Congress and Symposium Series No. 165, Royal Society of Medicine: London.Google Scholar
Sartorius, N. & Üstün, T.B. (1995). Mental Illness in Primary Care. An International Study. John Wiley and Sons: New York (in press).Google Scholar
Scott, A.I.F. & Freeman, C.P.L. (1992). Edinburgh primary care depression study: treatment, outcome, patient satisfaction and cost after 16 weeks. British Medical Journal 304, 883–887.CrossRefGoogle Scholar
Shiell, A., Gerard, K. & Donaldson, C. (1987). Cost of illness studies: an aid to decision-making? Health Policy 8, 317–323.CrossRefGoogle Scholar
Song, F., Freenmantle, N., Sheldon, T.A., House, A., Watson, P., Long, A. & Mason, J. (1993). Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. British Medical Journal 306, 683–687.CrossRefGoogle ScholarPubMed
Stewart, A.L. & Ware, J.E. (ed.) (1992). Measuring Functioning and Well Being: The Medical Outcomes Study Approach. Duke University Press: Durham, North Carolina.Google Scholar
Stoudemire, A., Frank, R., Hedemark, N., Kamlet, M. & Blazer, D. (1986). The economic burden of depression. General Hospital Psychiatry 8, 387–394.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Sartorius, N. (1993). The course and outcome of depression in different cultures: 10-year follow-up of the WHO Collaborative Study on the assessment of depressive disorders. Psychological Medicine 23, 1023–1032.CrossRefGoogle Scholar
Vampini, C. (1994). L'impiego dei farmaci antidepressivi negli anziani. Stato dell'arte. In A che Punto è la Psichiatria? (ed. Di Marco, G.), pp. 181–210. UPSEL Domeneghini Editore: Padova.Google Scholar
Wechsler, B.E. & Nelson, J.C. (1994). Il trattamento dei disturbi depressivi maggiori. Rivista Sperimentale di Freniatria 118, 11–50.Google Scholar
Weissman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P. & Hoizer, C. (1991). Affective disorders. In Psychiatric Disorders in America: the Epidemiologic Catchment Area Study (ed. Robins, L.N. and Regier, D.A.), pp. 53–88. Free Press: New York.Google Scholar
Wells, K.B., Stewart, A., Hays, R.D., et al. (1989). The functioning and well-being of depressed patients. Journal of the American Medical Association 262, 916–919.Google ScholarPubMed
Wernicke, J.F., Dunlop, S.R. & Dornseif, B.E. (1988). Low-dose fluoxetine therapy for depression. Psychopharmacology Bulletin 24, 183–188.Google ScholarPubMed
West, R. (1992). Depression. Office of Health Economics: London.Google Scholar
Wilde, M.I., Plosker, G.L. & Benfield, P. (1993). Fluvoxamine. An updated review of its pharmacology and therapeutic use in depresssive illness. Drugs 46, 895–924.CrossRefGoogle Scholar
World Bank (1993). World Development Report 1993: Investing in Health. Oxford University Press: Oxford.Google Scholar