Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine release_rev_960d0083-f766-41e8-8224-4aa87bc80db6

Abstract

<jats:sec> <jats:title>Background</jats:title> The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care. </jats:sec> <jats:sec> <jats:title>Aims</jats:title> To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care. </jats:sec> <jats:sec> <jats:title>Method</jats:title> An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression. </jats:sec> <jats:sec> <jats:title>Results</jats:title> No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were $762 (95% CI 553–1059) for TCAs, $875 (95% CI 675–1355) for SSRIs and $867 (95% CI 634–1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6). </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care. </jats:sec>
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