Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
The economics of selective serotonin reuptake inhibitors in depression - Acritical review
Autore:
Frank, L; Revicki, DA; Sorensen, SV; Shih, YCT;
Indirizzi:
MEDTAP Int, Ctr Hlth Outcome Res, Bethesda, MD 20814 USA MEDTAP Int Bethesda MD USA 20814 Hlth Outcome Res, Bethesda, MD 20814 USA
Titolo Testata:
CNS DRUGS
fascicolo: 1, volume: 15, anno: 2001,
pagine: 59 - 83
SICI:
1172-7047(2001)15:1<59:TEOSSR>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
QUALITY-OF-LIFE; HEALTH MAINTENANCE ORGANIZATION; NATIONAL-COMORBIDITY-SURVEY; COST-EFFECTIVENESS; PRIMARY-CARE; ANTIDEPRESSANT PHARMACOTHERAPY; MAJOR DEPRESSION; PHARMACOECONOMIC EVALUATION; REAL-WORLD; TRICYCLIC ANTIDEPRESSANTS;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
98
Recensione:
Indirizzi per estratti:
Indirizzo: Revicki, DA MEDTAP Int, Ctr Hlth Outcome Res, 7101 Wisconsin Ave,Suite 600, Bethesda, MD 20814 USA MEDTAP Int 7101 Wisconsin Ave,Suite 600 Bethesda MD USA 20814
Citazione:
L. Frank et al., "The economics of selective serotonin reuptake inhibitors in depression - Acritical review", CNS DRUGS, 15(1), 2001, pp. 59-83

Abstract

The prevalence of depression and the high costs associated with its treatment have increased interest in pharmacoeconomic evaluations of drug treatment, particularly in the 1990s as the use of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) expanded substantially. This review presents results from specific studies representing the key study designs used to address the pharmacoeconomics of SSRI use: retrospective administrative database analyses, clinical decision analysis models, and randomised clinical trials. Methodological considerations in interpreting results are highlighted. In retrospective administrative database analyses, most comparisons have been made between SSRIs and tricyclic antidepressants (TCAs). A few studies have addressed differences between SSRIs. The studies focused on healthcarecost (to payer) and cost-related outcomes (e.g. treatment duration, drug switching). Although SSRls are generally associated with higher drug acquisition costs than are TCAs, total healthcare costs are at least offset, if not decreased, by reductions in costs associated with use of SSRIs. Although studies from the early 1990s show some advantage for fluoxetine, the results are limited by use of data from shortly after the introduction of paroxetine and sertraline; studies from the mid-1990s on that compare drugs withinthe SSRI class show general equivalence in terms of cost. Important methodological advances are occurring in retrospective studies, with selection bias and other design limitations being addressed statistically. Clinical decision analysis models permit flexibility in terms of ability to specify different alternative treatment scenarios and varying durations. Sensitivity analysis aids interpretability, although model inputs are limited by data availability. Results from short term (1 year duration or less) studies comparing SSRIs and TCAs suggest that SSRIs are more cost effectiveor that there is no difference. Longer term studies (lifetime Markov models) focus more on the impact of maintenance antidepressant therapy and show more mixed results, generally favouring SSRIs over TCAs. The results indicate that the effect of SSRIs is mainly through prevention of relapse. Important assumptions of these models include fewer serious adverse effects and lower treatment discontinuation rates with SSRIs. Naturalistic clinical trials provide greater generalisability than traditional randomised clinical trials. One naturalistic trial found that nearly half of TCA-treated patients switched to another antidepressant within 6 months; only 20% of SSRI-treated patients switched. Cost differences between groups were minimal. These studies indicate few differences in medical costs, depression outcomes and health-related quality of life between TCAs and fluoxetine, although fewer fluoxetine-treated patients switched treatment.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 23/01/20 alle ore 04:06:33