Fluoxetine and imipramine: are there differences in cost-utility for depression in primary care?

Autor:	Antoni, Serrano-Blanco, David, Suárez, Alejandra, Pinto-Meza, Maria T, Peñarrubia, Josep Maria, Haro, Josep Maria Haro, Abad
Rok vydání:	2009
Předmět:	Adult Male Imipramine medicine.medical_specialty Antidepressive Agents Tricyclic Indirect costs Quality of life Fluoxetine Surveys and Questionnaires Humans Medicine Psychiatry health care economics and organizations Depression (differential diagnoses) Cost–utility analysis Primary Health Care Depression business.industry Health Policy Public Health Environmental and Occupational Health Middle Aged Clinical research Costs and Cost Analysis Antidepressive Agents Second-Generation Antidepressant Female business medicine.drug
Zdroj:	Journal of Evaluation in Clinical Practice. 15:195-203
ISSN:	1365-2753 1356-1294
DOI:	10.1111/j.1365-2753.2008.00982.x
Popis:	Rationale Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses. Objective To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care. Methods A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner’s usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR’s sampling distribution, non-parametric bootstrapping was carried out. Results Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant. Conclusion Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.
Databáze:	OpenAIRE
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