Background A recent simulation concluded that the serotonin-specific reuptake inhibitor (SSRI) paroxetine was more cost-effective than the tricyclic anti-depressant (TCA) imipramine, despite substantially higher medication acquisition costs.
Method We replicated the previous model and revised key assumptions which drove the results.
The revised model was subjected to sensitivity analysis.
Results Most scenarios in the revised model showed that theTCA is equally or more cost-effective than the SSRI.
Model revisions producing these results were changes in assumptions about switched treatment success rates, treatment length and initial treatment success.
The revised model appears sensitive to drug acquisition and delivery costs and costs oftreatment failure.
Conclusions Based on the model, a policy of usingTCAs as first-choice antidepressant treatment, with SSRls reserved for those patients not doing well initially appears more cost-effective than the reverse sequence.
Given limitations in current knowledge about key parameters to include in a simulation model, large prospective random-assignment cost-effectiveness studies are needed.
Mots-clés Pascal : Paroxétine, Inhibiteur recapture, Sérotonine, Etude comparative, Imipramine, Composé tricyclique, Antidépresseur, Psychotrope, Chimiothérapie, Traitement, Analyse coût, Economie santé, Homme, Pipéridine dérivé
Mots-clés Pascal anglais : Paroxetine, Reuptake inhibitor, Serotonin, Comparative study, Imipramine, Tricyclic compound, Antidepressant agent, Psychotropic, Chemotherapy, Treatment, Cost analysis, Health economy, Human, Piperidine derivatives
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0274455
Code Inist : 002B02B02. Création : 15/07/1997.