Modelling the Cost Effectiveness of Antidepressant Treatment in Primary Care

摘要: The aim of this study was to estimate the cost effectiveness nefazodone compared with imipramine or fluoxetine in treating women major depressive disorder. Clinical decision analysis and a Markov state-transition model were used lifetime health outcomes medical costs 3 antidepressant treatments. model, which represents ideal primary care practice, compares treatment either fluoxetine. economic based on healthcare system Canadian province Ontario, considered only direct costs. Health expressed as quality-adjusted life years (QALYs) 1993 dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios calculated comparing relative discounted QALYs associated those Data for constructing estimating necessary parameters derived from literature, clinical trial data, physician judgement. included information on: Ontario physicians' management depression; resource use costs; probabilities recurrence suicide rates; compliance utilities. Estimates utilities depression-related hypothetical states obtained patients depression (n 70). Medical present value using 5% rate. Sensitivity analyses tested assumptions by varying discount rate, rates, duration model. base case found that $Can1447 less per patient than (discounted $Can50,664 vs $Can52,111) increases number 0.72 (13.90 13.18). Nefazodone $Can14 (estimated $Can50,678) produces slightly more 13.79). In sensitivity analyses, cost-effectiveness ranged saving $Can17,326 QALY gained. $Can7327 most sensitive about rates rates. findings suggest may be cost-effective basic conclusions do not change even after modifying within reasonable ranges.