Cost-effectiveness evaluation of escitalopram in major depressive disorder in Italy

Abstract

BackgroundDepression has a lifetime prevalence of 10%–25% among women and 5%–12% among men. Selective serotonin reuptake inhibitors (SSRIs) are the most used and the most cost-effective treatment for long-term major depressive disorder. Since the introduction of generic SSRIs, the costs of branded drugs have been questioned. The objective of this study was to assess the cost-effectiveness (€ per quality-adjusted life year [QALY]) of escitalopram (which is still covered by a patent) compared with paroxetine, sertraline, and citalopram, the patents for which have expired.MethodsA decision analytic model was adapted from the Swedish Dental and Pharmaceutical benefits agency model to reflect current clinical practice in the treatment of depression in Italy in collaboration with an expert panel of Italian psychiatrists and health economists. The population comprised patients with a first diagnosis of major depressive disorder and receiving for the first time one of the following SSRIs: escitalopram, sertraline, paroxetine, and citalopram. The time frame used was 12 months. Efficacy and utility data for the original model were validated by our expert panel. Local data were considered for resource utilization and for treatment costs based on the Lombardy region health service perspective. Several scenario simulations, oneway sensitivity analyses, and Monte Carlo simulations were performed to test the robustness of the model.ResultsThe base case scenario showed that escitalopram had an incremental cost-effectiveness ratio (ICER) of €4395 and €1080 per QALY compared with sertraline and paroxetine, respectively. Escitalopram was dominant over citalopram, which was confirmed by most one-way sensitivity analyses. The escitalopram strategy gained 0.011 QALYs more than citalopram, 0.008 more than paroxetine, and around 0.007 more than sertraline. Monte Carlo simulations indicated that ICER values for escitalopram were centered around €1100 and €4400 per QALY compared with paroxetine and sertraline, respectively. Although there is no official cost-effectiveness threshold in Italy, the value of €25,000 per QALY could be acceptable. All ICER values retrieved in all analyses were lower than this threshold.ConclusionThe findings from this cost-effectiveness analysis indicate that escitalopram could be accepted as a cost-effective strategy for the Lombardy region health service compared with the other SSRIs studied. The present assessment is based on ICER values resulting from this analysis, which are lower than the thresholds proposed by health care authorities in other European Union countries. These benefits are driven by the effectiveness of escitalopram, which result in an improved health-related quality of life, a higher probability of sustained remission, and better utilization of health care resources. The study results are robust and in line with other pharmacoeconomic analyses comparing escitalopram with other SSRIs.

<p>Cost-effectiveness and budget impact analysis of viscosupplementation with hylan G-F 20 for knee and hip osteoarthritis</p>

“…The results show that hylan G-F 20 1×6 mL and hylan G-F 20 3×2 mL for OA knee treatment are very likely to be cost-effective compared to acetaminophen and NSAIDs as the ICERs for both comparisons are well below €25,000, one of the suggested cost-effectiveness thresholds for Italy (Mencacci et al, 2013)43 (Tables 2 and 3).…”

C-QUALITY: cost and quality-of-life pharmacoeconomic analysis of antidepressants used in major depressive disorder in the regional Italian settings of Veneto and Sardinia

“…Remission probabilities of these treatments were assessed as the mean value of each drug class considered in the STAR*D study and Mencacci et al15 (Table 3). It was assumed that the risk of relapse would be 11% and that relapse would occur after 4 months 19.…”

“…An expert panel was organized to evaluate a pharmacoeconomic model developed by the Swedish Dental and Pharmaceutical Benefits Agency (TLV) 14 , 15 and to adapt it to Italian clinical practice. The panel comprised eight psychiatrists from different Italian regions and two health economists from an independent agency.…”

“…Regarding second, third, and fourth treatment lines, the expert panel agreed to adapt STAR*D remission probabilities to the treatments not considered in the STAR*D study, but usually administered in normal Italian clinical practice. Remission probabilities of these treatments were assessed as the mean value of each drug class considered in the STAR*D study and Mencacci et al 15 ( Table 3 ). It was assumed that the risk of relapse would be 11% and that relapse would occur after 4 months.…”

“…It was assumed that the risk of relapse would be 11% and that relapse would occur after 4 months. 19 For suicide attempts and the probability of dying in such an attempt, a probability value of 0.031 and 0.1, respectively, was set following the studies by Löthgren and Khan 20 , 21 and the work by Mencacci et al 15 ( Table 4 ).…”