Cost effectiveness analysis of escitalopram compared to venlafaxine and fluvoxamine in treatment of major depressive disorder

Objective. To compare the costs and effectiveness of escitalopram with venlafaxine and fluvoxamine for treatment of major depressive disorder (MDD) from the societal perspective in Singapore. Methods. The decision analytical model consisted of two pathways, one for primary care and the other for secondary care over a time horizon of 6 months. The parameters in the model were derived from clinical trials and results of a survey on local general practitioners and psychiatrists. The proportion of patients successfully treated was the main effectiveness measurement. Both direct and indirect costs were estimated and reported in 2007 Singapore dollars. Deterministic and probabilistic sensitivity analyses were performed. Results. The overall success rate for the 6-month treatment was 68.1% for escitalopram compared to 66.0% for venlafaxine. The total costs per patient treated were $2845 for escitalopram compared to $3176 for venlafaxine. The overall success rate was 64.7% for escitalopram and 60.0% for fluvoxamine. The total costs per patient treated were $3133 for escitalopram compared to $3297 for fluvoxamine. Probability sensitivity analysis demonstrated that escitalopram was dominant to venlafaxine and fluvoxamine in more than 95% of the random samples. Conclusion. Escitalopram is a cost-effective pharmacotherapy for MDD compared to venlafaxine and fluvoxamine.