Are SSRIs a cost-effective alternative to tricyclics ?
Selective serotonin reuptake inhibitors (SSRls) are more expensive than tricyclics.
Reports have suggested that SSRls are cost-effective because they are better tolerated and safer in overdose.
A systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRls and tricyclic antidepressants (TCAs).
None of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach.
Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRls drop out of RCTs.
Cost-effectiveness studies have been based on crude'modelling'approaches and over-estimate the difference in attrition rates and the cost of treatment failure.
It appears impossible to evaluate the economic aspects of suicide because of its rarity.
There is no evidence to suggest that SSRls are more cost-effective than TCAs.
The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.
Mots-clés Pascal : Antidépresseur, Psychotrope, Composé tricyclique, Etude comparative, Inhibiteur recapture, Sérotonine, Analyse coût, Economie santé, Chimiothérapie, Traitement, Article synthèse, Métaanalyse, Homme
Mots-clés Pascal anglais : Antidepressant agent, Psychotropic, Tricyclic compound, Comparative study, Reuptake inhibitor, Serotonin, Cost analysis, Health economy, Chemotherapy, Treatment, Review, Metaanalysis, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0217639
Code Inist : 002B02B02. Création : 199608.