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], > or =18 to < or =40) 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 (ie, remission [defined as MADRS < or =12]) 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 (1.0 approximately USD 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 Euros 390 (95% CI, Euros 372-Euros 409) for escitalopram compared with Euros 411 (95 % CI, Euros 391-Euros 431) for citalopram. From the societal perspective, these costs were Euros 1162 (95% CI, Euros 1106-Euros 1221) and Euros 1276 (95% CI, Euros 1216-Euros 1336), 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.