OBJECTIVES: The purpose of this study is to assess
the cost-effectiveness of escitalopram, a new selective
serotonin reuptake inhibitor (SSRI), versus citalopram,
fluoxetine, and venlafaxine in Sweden.
METHODS: Cost-effective analysis is performed using
a two-path decision analytic model with a 6-month
horizon. Patients start at the primary path, and are
referred to specialist care in the secondary care path. This
is typical of a GP/Psychiatrist setting. Model inputs
include drug-specific probabilities from comparative trial
data, published literature, and a clinical experts’ panel.
The primary outcome measure is ‘success’, defined as
patients in remission 6 months after the start of treatment.
The model combines success rates and expected
costs to calculate the cost-effectiveness ratios. The
estimated number of patient episodes during each drug
treatment (using IMS volume sales) are combined with
the average 6-month per-patient expected costs of treat
ment (total and drug costs) to estimate the effect of the
introduction of escitalopram on the health care budget.
RESULTS: Treatment of Major Depressive Disorder with
escitalopram yielded a lower expected cost and greater
effectiveness compared to other SSRIs and SNRIs. The
expected success rate (remission) was 63.5% for escitalopram,
compared to 57.2%, 57.0%, and 61.1% for
citalopram, fluoxetine, and venlafaxine, respectively.
Average expected total medical costs per patient are
similar for escitalopram (SEK 15,670) and venlafaxine
(SEK 16,580), and somewhat higher for citalopram and
fluoxetine (SEK 18,860 and 19,050 respectively). Budgetary
impact shows that the increase in drug costs
(increase in Drug Budget estimated at SEK 44 million) is
more than offset by the decrease in other health care costs
(decrease in total Health Care Budget estimated at SEK
CONCLUSIONS: Escitalopram is a cost-effective
treatment alternative to citalopram, fluoxetine, and venlafaxine.
The results of this study indicate that increased
utilisation of escitalopram might reduce health care costs