A critical review of selected pharmacoeconomic analyses of antidepressant therapy

OBJECTIVE: To evaluate the pharmacoeconomic benefits of treating depression and compare the available therapies by reviewing the current literature on economic analyses of depression. DATA SOURCES: A MEDLINE search (January 1966-June 1998) of English-language literature relating to economic analyses of depression was conducted. Key search terms included depression, antidepressant, economics, pharmacoeconomics, outcomes, and costs. Additional literature was collected from reference lists of articles found through the MEDLINE search. STUDY SELECTION AND DATA EXTRACTION: A MEDLINE search was performed using the above key words. Search and evaluation were limited to pharmacoeconomic evaluations of major depressive disorder. All available studies were considered for inclusion in the review. DATA SYNTHESIS: The advent of newer, brand-name antidepressants as well as increased concern regarding healthcare costs has raised interest in the costs associated with treating depression. Although the selective serotonin-reuptake inhibitors (SSRIs) and other newer antidepressants have higher acquisition costs, both modeling and naturalistic studies have shown that the total cost of treating depression is no higher with SSRIs than with the tricyclic antidepressants. These differences are primarily due to increased patient adherence with the newer agents and lower costs secondary to physician visits, laboratory monitoring, and hospitalization. CONCLUSIONS: The economic aspects of treating depression are becoming more frequently evaluated as newer antidepressant medications become available and as healthcare entities attempt to address increasing costs. In general, most pharmacoeconomic research on depression has been conducted on one of the SSRIs in comparison with various tricyclic antidepressants. These studies frequently use simulation techniques and rely heavily on data from clinical trials. Few studies have compared the newer antidepressants, and no clear evidence exists that any one of these agents is more cost-effective than others. Even fewer studies have addressed the pharmacoeconomics of medication management of depression in various healthcare environments (e.g., public mental health care vs. private psychiatry vs. primary care).