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A pharmacoeconomic evaluation of major depressive disorder (Italy)

Published online by Cambridge University Press:  11 October 2011

Julian Casciano ,
Steven Arikian ,
Jean-Eric Tarride ,
John J. Doyle  and
Roman Casciano
Julian Casciano
Affiliation:
1The Analytica Group, New York (USA)
Steven Arikian
Affiliation:
1The Analytica Group, New York (USA) 2Columbia University, School of Public Health
Jean-Eric Tarride
Affiliation:
1The Analytica Group, New York (USA) 3Concordia University, Department of Economics
John J. Doyle
Affiliation:
1The Analytica Group, New York (USA) 2Columbia University, School of Public Health
Roman Casciano*
Affiliation:
1The Analytica Group, New York (USA)
*
Indirizzo per la corrispondenza: Dr. R. Casciano, The Analytica Group, 475 Park Avenue South, New York, NY 10016 (USA). Fax: +1-212-686.8601 E-mail: rcasciano@groupanalytica.com
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Summary

Objective – To determine the most cost-effective oral therapy for the treatment of Major Depressive Disorder (MDD) in Italy. Method – We conducted a pharmacoeconomic evaluation based on a decision analytic model that examined the treatment of major depressive disorder (MDD) in Italy. The analysis compared the serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine extended-release (venlafaxine XR), to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). A meta-analysis was performed to determine the clinical rates of success. The meta-analytic rates were applied to the decision analytic model to calculate the expected cost and expected outcomes for each anti-depressant comparator. Cost-effectiveness was determined using the expected values for both a successful outcome, and a composite measure of outcome termed ‘symptom-free days’. A policy analysis was conducted to estimate the financial impact to the Servizio Sanitario Nazionale (SSN). Results – Treatment of MDD with venlafaxine XR yielded the highest overall efficacy rates for outpatients (73.7%) versus SSRIs (61.4%) and TCAs (59.3%), and inpatients (62.3%) versus SSRIs (58.6%) and TCAs (58.2%). Venlafaxine XR had the lowest dropout rates due to lack of efficacy (4.8%) versus SSRIs (8.4%) and TCAs (6.8%), and adverse drug reactions (10.9%) versus SSRIs (17.4%) and TCAs (23.1%). Initiating treatment of MDD with venlafaxine XR yielded the lowest expected cost for outpatients and for inpatients. The total resulting savings for the SSN at a 5% venlafaxine XR utilization was estimated between L 963 million and L 3,210 million. Conclusion – This study confirms that venlafaxine XR is generally a cost-effective treatment of MDD. Additionally, the results of this investigation suggest that increased utilization of venlafaxine XR will favorably impact the SSN.

Riassunto

Scopo – Determinare la terapia orale più efficace in termini di costi per il trattamento della depressione maggiore in Italia. Metodo – Abbiamo condotto una valutazione farmacoeconomica basata su un modello analitico di decisione che esaminava il trattamento della depressione maggiore in Italia. L'analisi confrontava l'inibitore della ricaptazione della serotonina e della norepinefrina (SNRI), venlafaxina extended-release (venlafaxina XR), con gli inibitori selettivi della ricaptazione della serotonina (SSRI) e gli antidepressivi triciclici (TCA). È stata condotta una meta-analisi per determinare gli indici clinici di successo. Gli indici meta-analitici sono stati applicati al modello analitico decisionale per calcolare i costi ed i risultati previsti per ogni antidepressivo messo a confronto. L'efficacia dei costi à stata determinata usando i valori previsti sia per un risultato positivo che per una scala di misurazione di risultati composta defmita «giorni privi di sintomi». È stata condotta un'analisi della politica per valutare l'impatto economico sul Sistema Sanitario Nazionale (SSN). Risultati – Il trattamento della depressione maggiore con venlafaxina XR ha ottenuto il più alto l'indice di efficacia generale per i pazienti ambulatoriali (73.7%) contro SSRIs (61.4%) e TCAs (59.3%) e, per i pazienti ricoverati (62.3 %) contro SSRIs (58.6%) e TCAs (58.2%). Venlafaxina XR ha registrato il più basso indice di interruzione terapeutica dovuta ad inefficacia (4.8%) contro SSRIs (8.4%) e TCAs (6.8%), e di reazioni avverse al farmaco (10.9%) contro SSRIs (17.4%) e TCAs (23.1%). L'inizio del trattamento della depressione maggiore con venlafaxina XR ha fatto ottenere i costi previsti più bassi per i pazienti ambulatoriali è per quelli ricoverati. Il risparmio totale risultante per il SSN con un utilizzo di venlafaxina XR pari al 5% è stato stimato tra i 963 e i 3,210 milioni di lire. Conclusioni – Questo studio conferma che venlafaxina XR è generalmente un trattamento efficace in termini di costi della depressione in Italia. Inoltre, i risultati di questa ricerca suggeriscono che un maggiore impiego di venlafaxina XR avrà un impatto favorevole sul SSN.

Keywords

depressionvenlafaxinetryciclicsSSRISNRIefficacymeta-analysiscost-effectivenessdecision treedepressionevenlafaxinatricicliciSSRISNRIefficaciameta-analysiscosto-efficaciaalbero decisionale.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 8 , Issue 3 , September 1999 , pp. 220 - 231
Copyright
Copyright © Cambridge University Press 1999

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