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CNS Drugs
Erschienen in: CNS Drugs 8/2015

01.08.2015 | Original Research Article

Network Meta-Analysis and Cost-Effectiveness Analysis of New Generation Antidepressants

verfasst von: Ai Leng Khoo, Hui Jun Zhou, Monica Teng, Liang Lin, Ying Jiao Zhao, Lay Beng Soh, Yee Ming Mok, Boon Peng Lim, Kok Peng Gwee

Erschienen in: CNS Drugs | Ausgabe 8/2015

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Abstract

Background

Major depressive disorder (MDD) impacts health, quality of life and workplace productivity. Antidepressant treatment is the primary therapeutic intervention. This study assessed the efficacy and tolerability of new generation antidepressants and their cost-effectiveness in the Singapore healthcare system.

Methods

We conducted a systematic search for head-to-head randomised controlled trials on ten antidepressants (agomelatine, duloxetine, escitalopram, fluvoxamine, fluoxetine, mirtazapine, paroxetine, sertraline, trazodone and venlafaxine) employed as monotherapy in acute MDD management. We performed a network meta-analysis to compare their relative efficacy. The outcome measures for efficacy were response and remission rate, and mean change in Hamilton Depression Rating Scale (HDRS) score; and for tolerability, study withdrawal rates due to adverse events. To evaluate their relative cost effectiveness, a decision tree simulating a cohort of MDD patients using antidepressant as monotherapy was constructed from a societal perspective over 6 months. We used effectiveness data from our network meta-analysis and local data on resource use for depression in Singapore. The incremental cost expected for each additional quality-adjusted life-year (QALY) gained was calculated and presented as the incremental cost-effectiveness ratio (ICER).

Results

We identified 76 relevant articles for the network meta-analysis. Of the ten agents included in the analysis, mirtazapine and agomelatine were most efficacious in achieving response and remission, respectively. Mirtazapine and duloxetine resulted in the greatest magnitude of change in the HDRS score. Agomelatine, escitalopram and sertraline were the best tolerated of the drugs analysed, while duloxetine was the least well tolerated drug. Using a composite outcome of efficacy (response and remission rates) and tolerability, agomelatine, escitalopram and mirtazapine were the favoured treatments. In the cost-effectiveness analysis, apart from agomelatine, all the treatments were dominated by mirtazapine. Against mirtazapine, agomelatine was not cost effective given that its ICER exceeded the threshold value.

Conclusion

Agomelatine, escitalopram and mirtazapine had favourable balance between efficacy and tolerability. In addition, mirtazapine was a cost-effective option in the Singapore healthcare system.
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Metadaten
Titel
Network Meta-Analysis and Cost-Effectiveness Analysis of New Generation Antidepressants
verfasst von
Ai Leng Khoo
Hui Jun Zhou
Monica Teng
Liang Lin
Ying Jiao Zhao
Lay Beng Soh
Yee Ming Mok
Boon Peng Lim
Kok Peng Gwee
Publikationsdatum
01.08.2015
Verlag
Springer International Publishing
Erschienen in
CNS Drugs / Ausgabe 8/2015
Print ISSN: 1172-7047
Elektronische ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-015-0267-6

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