Objective
To evaluate the cost effectiveness of four different mechanisms clinical commonly used antidepressants, namely, amitriptyline, escitalopram, mirtazapine and venlafaxine in the treatment of moderate-severe depressive disorder in China and to provide clinicians with some advice.
Methods
We carried out the cost-effectiveness analysis of four antidepressants by establishing a decision tree model. The parameters uncertainty in the model was estimated through one-way sensitivity analysis.
Results
In terms of average cost-effectiveness ratio (CER), amitriptyline’s was 45.24 RMB, which was the lowest. And the CERs of mirtazapine, escitalopram and venlafaxine were 273.71 RMB, 332.00 RMB and 716.58 RMB, respectively. While in terms of incremental cost-effectiveness ratio (ICER), venlafaxine was excluded as the dominated strategy. When the threshold value of willingness to pay (WTP) was less than 3 420.92 RMB, amitriptyline was the most cost-effective; when the threshold value ranges between 3 420.92 RMB and 4 200 RMB, mirtazapine was the most cost-effective; and when the threshold value was over 4 200 RMB, escitalopram was the most cost-effective. In the one-way sensitivity analysis, when we changed the four kinds of drugs costs within a certain range, the results was not changed with the change of venlafaxine’s cost but changed with the other three drugs costs.
Conclusion
Clinicians may choose the most cost-effective therapy according to patients’ different WTP values. We suggests that health care institutions should encourage the use of escitalopram clinically and provide subsidies for patients so as to increase the overall society benefit.
Citation：
LIUQiang, LIHong-chao, MAAi-xia. Cost-Effectiveness Analysis of Clinical Commonly Used Drug Options in the Treatment of Moderate-Severe Depressive Disorder in China: A Decision Tree Model. Chinese Journal of Evidence-Based Medicine, 2016, 16(6): 628-634. doi: 10.7507/1672-2531.20160097
Copy
Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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- 1. Bland RC. Epidemiology of affective disorder: a review. Can J Psy-chiatry, 1997, 42(4): 367.
- 2. 舒良. 抑郁症的评定与治疗. 中华医学杂志, 1999, 79(5): 398-400.
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- 4. 李凌江, 马辛. 中国抑郁障碍防治指南. 第2版. 中华医学电子音像出版社, 2015.
- 5. 周宇, 林兰荣, 吴坤丰. 艾司西酞普兰与文拉法辛治疗抑郁障碍的成本-效果分析. 中国药物经济学, 2013, 8(4): 16-18.
- 6. 朱云泽. 三种抗抑郁药物治疗方案的成本-效果分析. 人人健康(医学导刊), 2008, (5): 86.
- 7. 温预关, 陈伟家, 王玲芝, 等. 三种抗抑郁药治疗抑郁症的成本-效果分析. 中国药业, 2003, 12(2): 68-69.
- 8. 许德河, 孙颖. 抗抑郁药治疗抑郁症的成本-效果分析. 中国药业, 2006, 15(17): 53-54.
- 9. 陈策, 陈光东, 土文珍, 等. 四种新型抗抑郁药治疗抑郁症的成本-效果评价. 医院管理论坛, 2014, 31(10): 39-41.
- 10. 尹榕, 刘曌, 张国桢, 等. Wingspan支架治疗颅内动脉粥样硬化性狭窄单组率的Meta分析. 中国循证医学杂志, 2015, 15(3): 295-304.
- 11. Annemans L, Brignone M, Druais S, et al. Cost-Effectiveness Analysis of Pharmaceutical Treatment Options in the First-Line Management of Major Depressive Disorder in Belgium. PharmacoEconomics, 2014, 32(5): 479-493.
- 12. 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(8): e42003.
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