OBJECTIVES: British guidelines recommend escitalopram and
venlafaxine as second-line treatments in major depressive disorder
(MDD). Clinical trials demonstrated similar efficacy and
better tolerability of escitalopram vs. venlafaxine. To assess how
these results translate into real-life, this study compared secondline
treatment strategies with escitalopram or venlafaxine after
failure of first-line generic SSRI, based on drug utilisation and
economic outcomes in patients with MDD in the UK.
METHODS: This cohort study using the General Practitioners
Research Database (GPRD) included adults with a diagnosis of
MDD, who had switched from a first-line generic SSRI to escitalopram
or venlafaxine between January 1, 2003 and June 30,
2005. A 6-month drug utilisation outcomes were doseadjustments,
mean treatment duration (TD), and successful
treatment stop (no subsequent need for treatment) after switch.
6-month economic outcomes were health care resource use and
total health care costs, calculated by adding up unit costs
applied to resources. Appropriate multivariate models were
built, using propensity scoring to control on baseline characteristics.
RESULTS: A total of 535 patients were switched to escitalopram,
1284 to venlafaxine. In the escitalopram cohort
compared with the venlafaxine cohort, there were fewer males
(32% vs. 38%, p = 0.02) and patients had a shorter median
time to switch (50 vs. 59 days, p = 0.005). Fewer drug adjustments
were needed with escitalopram (27% vs. 44%, p < 0.001); consequently, a shorter second-line treatment duration (106 vs. 123 days, p = 0.003), numerically more successful stops (37% vs. 32%, p = 0.25), and fewer GP visits (12.3 vs 13.4 visits/patient, p = 0.06) were observed in escitalopram-treated patients. 6-month total health care costs were significantly lower with escitalopram (£629 vs £749, p = 0.028), and were similar in both cohorts without treatment costs (£567 vs. £589, p = 0.73). CONCLUSIONS: After failure of a first generic SSRI, second-line treatment with escitalopram was associated with easier management, shorter second-line treatment duration and earlier success, with no increase in health care cost, compared with venlafaxine.