The Treatment of Major Depressive Disorders (MDD) in Thailand Using Escitalopram Compared to Fluoxetine and Venlafaxine: A Pharmacoeconomic Evaluation
Ronnachai Kongsakon MD, LLB, MSc (epi)*, Chanchai Bunchapattanasakda DBA, CMC**
Affiliation : * Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok ** School of Management, Shinawatra International University, Pathum Thani
A decision analytical model was used to compare expected health outcomes and costs of treating patients with major depression using new selective serotonin reuptake inhibitor (SSRI) escitalopram versus the other SSRI fluoxetine and the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine. The primary health outcome measure was an overall treatment success, defined as a remission (Montgomery-Åsberg Depression Rating Scale (MADRS) < 12), achieved over the 6 months of treatment. Estimated costs consisted of those directly related to treatment (drug acquisition costs, costs of psychiatric visits, hospital outpatient visits, hospitalization, and electroconvulsive therapy) and indirect costs associated with productivity lost due to depression. Clinical input parameters for the economic analyses were derived from published literatures. Resource utilization estimates were obtained from a survey of psychiatrists, while medical treatment patterns were determined from focus groups participated consisting from both general and family practitioners and psychiatrists. Unit costs (including daily cost of patient’s absence from work due to depression) were obtained from the standard sources. The unit cost of hospitalization was derived based on the average of factual service rates charged by the local hospital. The results show that escitalopram is more effective and less costly compared to fluoxetine and venlafaxine. Treatment using escitalopram produced the best-expected success rate and the lowest expected per patient cost. Escitalopram earned a savings of Baht 2,002 and Baht 1,768 compared to fluoxetine and venlafaxine respectively over a six-month period.
Keywords : Major depression, Escitalopram, Fluoxetine, Venlafaxine, Cost-effectiveness, SSRIs, SNRI
