Depression and pain: An appraisal of cost effectiveness and cost utility of antidepressants. (April 2015)

• Record Type: Journal Article
• Authors: Pan, Yi-Ju; Pan, Chun-Hao; Chan, Hung-Yu; Kuo, Kuei-Hong
• Is Part Of: Journal of psychiatric research. Volume 63(2015:Apr.)
• Page Start: 123
• Page End: 131
• Publication Date: 2015-04
• Subjects: Depression -- Pain -- Antidepressant -- Cost-effectiveness -- Cost-utility; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2015.01.019
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: Background: Although depression and chronic pain frequently co-occur, there is a lack of clarity in the literature regarding the cost-effectiveness and cost-utility of antidepressants in the presence of these two conditions. From the perspective of healthcare provider, the current study aims to compare the cost-effectiveness and cost-utility of antidepressants in a national cohort of depressed patients with and without comorbid pain conditions. Methods: Adult patients prescribed with antidepressants for depression were identified from the National Health Insurance Research Database in Taiwan (n = 96, 501). By using remission as effectiveness measure and quality-adjusted life years (QALYs) as utility measure, the cost-effectiveness and cost-utility were compared across selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), as well as by the presence of comorbid painful physical symptoms (PPS). Results: SSRIs dominated SNRIs in both the cost-effectiveness and cost-utility regardless of comorbid PPS. In comparison with TCAs, SSRIs were likely to be the cost-effective option for patients without PPS. In patients with PPS, the cost-utility advantage for SSRIs over TCAs varied with threshold willingness-to-pay levels. Comorbid PPS may be considered an effect modifier of the cost-utility comparisons between SSRIs and TCAs. Conclusions: For depressed patients without PPS, SSRIs are likely to be cost-effective in improving remission rates and QALYs compared to TCAs and SNRIs. However, to improve cost-utility in those with comorbid PPS, people need to choose between SSRIs and TCAs according to threshold willingness-to-pay levels. Future research is warranted to clarify the impacts of different pain conditions on the economic evaluations of pharmacological treatments in patients with depression. Highlights: In this study, SSRIs were found to dominate SNRIs in both the cost-effectiveness and cost-utility. For patients without painful physical symptoms (PPS), SSRIs were likely to be the cost-effective option. For those with PPS, the cost-utility advantage for SSRIs over TCAs varied with threshold willingness-to-pay levels. Comorbid PPS may be considered an effect modifier of the economic evaluation results for SSRIs versus TCAs.