A cost-effectiveness model of escitalopram, citalopram, and venlafaxine as first-line treatment for major depressive disorder in Belgium

Background: Economic evaluations aim to combine costs and patient outcomes in one analysis. Objective: The purpose of this study was to assess the cost-effectiveness of escitalopram (vs all available competitors) for first-line treatment of major depressive disorder (MDD) in Belgium. Methods: A 2-path decision analytic model with a 6-month horizon was used. All patients (baseline scores on the Montgomery-Asberg Depression Rating Scale [MADRS], greater than or equal to18 to greater than or equal to40) started at the primary path, and were referred to specialist care in the secondary care path. Model inputs included the following: probabilities from a meta-analysis of comparative trials data, an ad-hoc survey to evaluate pharmacologic treatment of depression in Belgium, literature, and a panel of experts. Main outcome measures were success (le, remission [defined as MADRS less than or equal to12]) and costs of treatment (ie, drug costs and medical care). Analyses were performed from the perspectives of the Belgian insurance system (IS) and society. The friction-cost method was used to estimate costs of lost productivity. Monetary values are reported in year-2003 euros (Euro1.0 approximate to US $1.1 in 2003). Results: The expected success rate was 62.3% (95% CI, 60.1%-64.5%) for escitalopram compared with 57.2% (95% CI, 55.0%-59.4%) for citalopram. From the IS perspective, the expected cost per patient was Euro390 (95% CI, Euro372-Euro409) for escitalopram compared with Euro411 (95% CI, Euro391-Euro431) for citalopram. From the societal perspective, these costs were Euro1162 (95% CI, Euro1106-Euro1221) and. Euro1276 (95% CI, Euro1216-Euro1336), respectively. The success rates of venlafaxine (66.6% [95% CI, 64.2%-69.0%]) and escitalopram (67.0% [95% CI, 64.7%-69.4%]) were similar, but higher total costs were observed with venlafaxine, due to acquisition and secondary care costs. The use of data from various sources may have introduced bias. However, sensitivity analyses demonstrated that results of the model were robust. Conclusions: In this analysis, the treatment of MDD with escitalopram appeared to be a cost-effective alternative compared with citalopram and venlafaxine, leading to better clinical outcomes and cost savings compared with citalopram in the model used. The success rates were similar between venlafaxine and escitalopram, but higher total costs were observed with venlafaxine. Copyright (C) 2005 Excerpta Medica, Inc.