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Abstract
The introduction of a new antidepressant, venlafaxine, a serotonin norepinephrine
reuptake inhibitor (SNRI), has provided researchers with the opportunity to take a
closer look at the issues involved in selecting a product for a formulary. To aid
decision makers in considering the adoption of this new therapy, a pharmacoeconomic
simulation model was developed to evaluate the cost-effectiveness of SNRIs versus
traditional oral therapies in the management of patients with major depressive disorders
(MDDs) from a cost-based payer perspective. Four treatment regimens for MDD were compared:
tricyclic antidepressants, selective serotonin reuptake inhibitors, heterocyclic antidepressants,
and SNRIs. The principles of decision analysis were used to calculate outcome probabilities
based on data from a meta-analysis. The expected cost of each regimen was calculated
using cost data from a survey of three health maintenance organizations located in
Missouri, Massachusetts, and California. The model suggests that SNRI therapy demonstrates
the highest level of cost-effectiveness in an inpatient setting when using both brand
and generic acquisition costs of the drugs. When comparing treatment regimens for
outpatients, the generic heterocyclic antidepressants demonstrate the highest level
of cost-effectiveness; when using brand acquisition costs, the SNRIs demonstrate the
highest level of cost-effectiveness. Sensitivity analysis calculated the robustness
of the conclusions to all major parameters.
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References
- Formularies: The role of pharmacy and therapeutics (P & T) committees.Clin Ther. 1993; 15: 433-441
- The formulary decision-making process in a HMO setting.PharmacoEconomics. 1994; 5: 29-38
- The emerging field of oral pharmaceuticals.J Am Dent Assoc. 1994; 125 (special edition): 2S-4S
- Comparison of venlafaxine and imipramine in the acute treatment of major depression in outpatients.J Clin Psychiatry. 1994; 55: 104-108
- Venlafaxine: A new dimension in antidepressant pharmacotherapy.J Clin Psychiatry. 1993; 54: 119-126
- Placebo-controlled trial of venlafaxine for the treatment of major depression.J Clin Psychopharmacol. 1991; 11: 233-236
- A comparison of venlafaxine, trazodone, and placebo in major depression.J Clin Psychopharmacol. 1994; 14: 99-106
- Cumulative mean change procedure: Application to a comparative trial of venlafaxine, imipramine, and placebo in the treatment of major depression.Prog Neuro-Psychopharmacol Biol Psychiatry. 1994; 18: 695-706
- How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations.Can Med Assoc J. 1992; 146: 473-481
- Avoiding bias in the conduct and reporting of cost-effectiveness research sponsored by pharmaceutical companies.NEJM. 1991; 324: 1362-1365
- Depression Guideline Panel. Treatment of major depression.Depression in Primary Care, II. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Rockville, Md1993
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Meta-analysis for combining Bayesian probabilities.Med Hypotheses. 1991; 35: 192-195
- Development of a rating scale for primary depressive illness.Br J Soc Clin Psychol. 1968; 6: 278-296
- Snesil NR 1993 Red Book. Medical Economics Data, Inc., Montvale, NJ1993
Data on file, Wyeth-Ayerst Laboratories, Philadelphia, PA.
- Physicians' Desk Reference®. Medical Economics Data Production Company, Montvale, NJ1994
- Crought CME 29th ed. Compendium of Pharmaceuticals and Specialties. Canadian Pharmaceuticals Association, Ottawa1994
Einarson TR, Arikian SR, Doyle J. Rank order stability analysis (ROSA): Testing pharmacoeconomic data. Med Decis Mak. In press.
- The cost of antidepressant drug therapy failure: A study of antidepressant use patterns in a medicaid population.J Clin Psychiatry. 1990; 51 (Suppl): 60-71
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© 1995 Published by Elsevier Inc.
