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C-QUALITY: Cost and Quality-of-Life Pharmacoeconomic Analysis of Antidepressants in Major Depressive Disorder in Italy

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Abstract

Introduction

Major depressive disorder (MDD) is a common and disabling condition across the world. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly used antidepressants. The objective of this study was to assess the cost-effectiveness [€ per quality-adjusted life year (QALY)] of all SSRIs and all SNRIs for the treatment of MDD in Italy.

Methods

A decision analytic model was adapted from the Swedish Dental and Pharmaceutical Benefits agency model to reflect current clinical practice in the treatment of MDD in the largest Italian regions. This adaptation was possible thanks to the collaboration of an expert panel of Italian psychiatrists and health economists. The model evaluated patients with a first diagnosis of MDD and initiating an SSRI or an SNRI for the first time. The time horizon was 12 months. Efficacy and utility data for the model were retrieved from the literature and validated by the expert panel. Local data were considered for resource utilization and for treatment costs based on each regional health service perspective. Population-weighted regional data were used to define a national model. Scenario simulations, one-way sensitivity analyses, and Monte Carlo simulations were performed to test the robustness of the model.

Results

The base case analysis showed that escitalopram was associated with a lower total cost (€ 1,562) and a larger health gain (QALYs) at 1 year (0.732) per patient and dominated the other treatment strategies since more QALYs were achieved at a lower total cost. Sensitivity analyses support the robustness of the model.

Conclusion

The results indicate that escitalopram is the most cost-effective pharmacological treatment strategy for the Italian health service compared with other SSRIs and all SNRIs used in the first-line treatment of MDD.

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References

  1. Moussavi S, Chatterji S, Verdes E, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370:851–8.

    Article  PubMed  Google Scholar 

  2. Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9:90.

    Article  PubMed  Google Scholar 

  3. Colombo G, Di Matteo S. Nel Trattamento della Depressione Maggiore Nelle Diverse Regioni Italiane: Il Ruolo di Venlafaxina [Budget impact analysis in the treatment of major depressive disorder on Italian Regions: The role of venlafaxine]. Milan: W.H.E.RE. Medical Press Srl; 2009. Italian.

  4. Girolamo G, Polidori G, Morosini P, et al. Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;420:21–7.

    PubMed  Google Scholar 

  5. Mathers C, Boerma T, Ma Fat D. The global burden of disease: 2004 update. World Health Organization 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Accessed May 21, 2013.

  6. Battaglia A, Dubini A, Mannheimer R, Pancheri P. Depression in the Italian community: epidemiology and socio-economic implications. Int Clin Psychopharmacol. 2004;19:135–42.

    Article  PubMed  CAS  Google Scholar 

  7. Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64:1465–75.

    Article  PubMed  Google Scholar 

  8. Stoudemire A, Frank R, Hedemark N, Kamlet M, Blazer D. The economic burden of depression. Gen Hosp Psychiatry. 1986;8:387–94.

    Article  PubMed  CAS  Google Scholar 

  9. Kind P, Sorensen J. The costs of depression. Int Clin Psychopharmacol. 1993;7:191–5.

    Article  PubMed  CAS  Google Scholar 

  10. Kessler RC. The costs of depression. Psychiatr Clin North Am. 2012;35:1–14.

    Article  PubMed  Google Scholar 

  11. Frank L, Revicki DA, Sorensen SV, et al. The economics of selective serotonin reuptake inhibitors in depression: a critical review. CNS Drugs. 2001;15:59–83.

    Article  PubMed  CAS  Google Scholar 

  12. Panzarino PJ, Nash DB. Cost-effective treatment of depression with selective serotonin reuptake inhibitors. Am J Manag Care. 2001;7:173–84.

    PubMed  Google Scholar 

  13. Revicki DA, Simon GE, Chan K, et al. Depression, health-related quality of life, and medical cost outcomes of receiving recommended levels of antidepressant treatment. J Fam Pract. 1998;47:446–52.

    PubMed  CAS  Google Scholar 

  14. Ellis P. Australian and New Zealand clinical practice guidelines for the treatment of depression. Aust N Z J Psychiatry. 2004;38:389–407.

    Article  PubMed  Google Scholar 

  15. National Guideline Clearinghouse: Depression. The treatment and management of depression in adults [webpage on the Internet]. Guideline summary. London, UK: National Institute for Health and Clinical Excellence; 2009. http://guideline.gov/content.aspx?id=15521. Accessed May 21, 2013.

  16. Kennedy SH, Lam RW, Parikh SW, Patten SB, Ravindran AV. Canadian network for mood and anxiety treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. J Affect Disord. 2009;117:S1–2.

    Article  PubMed  Google Scholar 

  17. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373:746–58.

    Article  PubMed  CAS  Google Scholar 

  18. Aguglia et al. Use and treatment modalities for SSRI and SNRI in Italy in 2003–2009. Curr Med Res Opin. 2012;28:1–10.

    Article  Google Scholar 

  19. Taylor AT, Spruill WJ, Longe RL, Wade WE, Wagner PJ. Improved health-related quality of life with SSRIs and other antidepressants. Pharmacotherapy. 2001;21:189–94.

    Article  PubMed  CAS  Google Scholar 

  20. Wessling A, Ramsberg J. Depression: the review of antidepressants. Solna, Sweden: The Dental and Pharmaceutical Benefits Agency; 2008. http://www.tlv.se/Upload/genomgangen/review-antidepressants.pdf. Accessed May 21, 2013.

  21. Mencacci C, Di Sciascio G, Katz P, Ripellino C. Cost-effectiveness evaluation of escitalopram in major depressive disorder in Italy. Clinicoecon Outcomes Res. 2013;5:87–99.

    PubMed  Google Scholar 

  22. Gaynes B, Rush A, Madhukar T, Wisniewski S, Spencer D, Fava M. The STAR*D study: treating depression in the real world. Cleve Clin J Med. 2008;75:57–66.

    Article  PubMed  Google Scholar 

  23. Gilchrist G, Gunn J. Observational studies of depression in primary care: what do we know? BMC Fam Pract. 2007;8:28.

    Article  PubMed  Google Scholar 

  24. Lothgren M, Hemels M, Francois C, Joensson BA. Cost-effectiveness analysis of escitalopram as first line treatment of depression in Sweden. Prim Care Psychiatry. 2004;9:153–62.

    Article  Google Scholar 

  25. Khan A, Khan SR, Leventhal RM, Brown WA. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: a replication analysis of the Food and Drug Administration Database. Int J Neuropsychopharmacol. 2001;4:113–8.

    Article  PubMed  CAS  Google Scholar 

  26. Agenzia Italiana del Farmaco [homepage on the Internet]. Rome: Agenzia Italiana del Farmaco. http://www.agenziafarmaco.gov.it/. Accessed May 21, 2013.

  27. WHOCC [homepage on the Internet]. International language for drug utilization research. Oslo, Norway: World Health Organization Collaborating Center for Drug Statistics Methodology; updated May 4, 2012. http://www.whocc.no/. Accessed May 21, 2013.

  28. Sobocki P, Ekman M, Agren H, Runeson B, Jönsson B. The mission is remission: health economic consequences of achieving full remission with antidepressant treatment for depression. Int J Clin Pract. 2006;60:791–8.

    Article  PubMed  CAS  Google Scholar 

  29. Nordström G, Danchenko N, Despiegel N, Marteau F. Cost-effectiveness evaluation in Sweden of escitalopram compared with venlafaxine extended-release as first-line treatment in major depressive disorder. Value Health. 2012;15:231–9.

    Article  PubMed  Google Scholar 

  30. Ramsberg J, Asseburg C, Henriksson M. Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model. PLoS One. 2012;7:e42003.

    Article  PubMed  CAS  Google Scholar 

  31. Nuijten M, Brignone M, Marteau F, den Boer J, Hoencamp E. Cost-effectiveness of escitalopram in major depressive disorder in the Dutch health care. Clin Ther. 2012;34:1364–78.

    Article  PubMed  Google Scholar 

  32. Druais S, Gauthier A, Demyttenaeare K, Brignone M, de Pauw A, Defraigne G et al. An assessment of the cost-effectiveness of escitalopram vs. multiple comparators as first-line antidepressant in patients with major depressive disorder (MDD) in Belgium. ISPOR Congress, Berlin, November 2012.

  33. Evans C. The use of consensus methods and expert panels in pharmacoeconomic studies: practical applications and methodological shortcomings. Pharmacoeconomics. 1997;12:121–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Dr. Katz and Dr. Ripellino were responsible for model development and writing of the manuscript. Prof. Mencacci, Prof. Aguglia, Prof. Biggio, Prof. Cappellari, Prof. Di Sciascio, Prof. Fagiolini, Prof. Maina and Prof. Tortorella were responsible for clinical validation of the model and review of the manuscript. All authors read and approved the final manuscript. Furthermore Prof. Mencacci is the guarantor of the study and takes responsibility for the integrity of the work as a whole. This study and the article processing charges were financially supported by an unrestricted grant from Lundbeck Italy SpA, which was not responsible for creation of the study documents, the data analysis, data interpretation, or writing of the manuscript.

Conflict of interest

Prof. Mencacci, Prof. Aguglia, Prof. Biggio, Prof. Cappellari, Prof. Di Sciascio, Prof. Fagiolini, Prof. Maina and Prof. Tortorella have received honoraria from CSD Medical Research Srl. Dr. Katz and Dr. Ripellino are employees of CSD Medical Research Srl. Prof. Fagiolini has received research grants and/or is/has been a consultant and/or a speaker for Angelini, Astra Zeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, Eli Lilly, Janssen, Lundbeck, Novartis, Otsuka, Roche, Sigma Tau, and Takeda. Prof. Tortorella has been a speaker for Angelini, Astra Zeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Pfizer, Eli Lilly, Janssen, Lundbeck, Otsuka. The authors have indicated that they have no other conflict of interest with regard to the content of this article.

Ethical standards

The analysis in this article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Mental Health, Fatebenefratelli Hospital, Milan, Italy

    Claudio Mencacci

  2. Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy

    Eugenio Aguglia

  3. Department of Experimental Biology and Center of Excellence for the Neurobiology of Drug Dependence, University of Cagliari, Cagliari, Italy

    Giovanni Biggio

  4. Department of Mental Health, Camposampiero Hospital, Padua, Italy

    Lodovico Cappellari

  5. Department of Psychiatry, Policlinico Hospital, Bari, Italy

    Guido Di Sciascio

  6. Department of Molecular Medicine, University of Siena, Sienna, Italy

    Andrea Fagiolini

  7. Department of Mental Health, University of Siena Medical Center, Sienna, Italy

    Andrea Fagiolini

  8. Department of Neurosciences, University of Torino, Turin, Italy

    Giuseppe Maina

  9. Department of Mental Health, University of Naples, SUN, Naples, Italy

    Alfonso Tortorella

  10. CSD Medical Research Srl, Viale E. Jenner, 53, 20159, Milan, Italy

    Pablo Katz & Claudio Ripellino

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  1. Claudio Mencacci
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  2. Eugenio Aguglia
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  4. Lodovico Cappellari
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  7. Giuseppe Maina
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  8. Alfonso Tortorella
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  9. Pablo Katz
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  10. Claudio Ripellino
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Corresponding author

Correspondence to Claudio Ripellino.

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Mencacci, C., Aguglia, E., Biggio, G. et al. C-QUALITY: Cost and Quality-of-Life Pharmacoeconomic Analysis of Antidepressants in Major Depressive Disorder in Italy. Adv Ther 30, 697–712 (2013). https://doi.org/10.1007/s12325-013-0046-z

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  • DOI: https://doi.org/10.1007/s12325-013-0046-z

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