Summary
The objective of this study was to demonstrate the cost effectiveness of long term maintenance treatment with citalopram versus standard therapy (defined as short term antidepressant treatment) in patients with major depression in Germany. We chose doxepin, amitriptyline and trimipramine as standard therapy because these drugs are the leading antidepressants in that country. A Markov process analysis was used to model health status and economic outcomes as they accrued over a 1-year follow-up period. The main outcome measures were time without depression, direct costs and indirect costs (work days lost). All costs were in 1993 Deutschmarks. The clinical data were obtained from the published literature and US clinical practice guidelines; the associated unit costs of the medical resources used were derived from official German tariff lists. The results show that, compared with standard therapy, long-term maintenance treatment with citalopram is associated with a mean increase in time without depression of 7.9% (8.2 vs 7.6 months). The total costs of maintenance treatment with citalopram were substantially lower than with standard therapy (DM7985 vs DM11 948 per patient per year. In addition, both the direct and indirect costs of maintenance treatment with citalopram (DM3764 vs DM4221 per patient, respectively) were lower than with standard therapy (DM4577 vs DM7371 per patient, respectively). In conclusion, the study demonstrates that one year’s maintenance treatment with citalopram is both more effective and less costly than standard therapy in the treatment of patients with major depression.
Similar content being viewed by others
References
Brown GW, Craig TKJ, Harris TO. Depression: distress or disease? Some epidemiological considerations. Br J Psychiatry 1985; 147: 612–22
Regier DA, Myers JK, Kramer M, et al. The NIMH epidemiological catchment area program. Arch Gen Psychiatry 1984; 41 (10): 934–41
Myers JK, Weissman MM, Tischler GL, et al. Six-month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry 1984; 41: 959–67
Perris C. The course of depressive psychoses. Acta Psychiatr Scand 1968; 44: 238–48
Angst J. The epidemiology of depression. Psychopharmacology 1992; 106 Suppl.: 71–4
Carlson GA, Kotin JL, Davenport XB, et al. Follow-up of 53 bipolar manic-depressive patients. Br J Psychiatry 1990; 124: 134–9
Lehmann HE, Fenton FR, Deutch M, et al. An 11-year follow-up of 110 depressed patients. Acta Psychiatr Scand 1988; 78: 57–65
Stoudemire A, Frank R, Hedemark N, et al. The economic burden of depression. Gen Hosp Psychiatry 1986; 8: 387–94
Thase ME. Relapse and recurrences in unipolar depression: short-term and long-term approaches. J Clin Psychiatry 1990; 51 Suppl.: 51–7
Katon W, Von Korff M, Lin E, et al. Adequacy and duration of antidepressant treatment in primary care. Med Care 1992; 30: 67–76
Clinical practice guideline. Depression in primary care: treatment of major depression (AHCPR publication no. 93–0551). Rockville (MD): Public Health Service, Agency for Health Care Policy and Research, 1993
WHO Mental Health Collaborating Centres. Pharmacotherapy of depressive disorders: a consensus statement. J Affect Disord 1989; 17: 197–8
Montgomery SA, Dunbar GC. Paroxetine is better than placebo in relapse prevention and the prophylaxis of recurrent depression. Int Clin Psychopharmacol 1993; 8: 189–95
National Institute of Mental Health. A consensus development conference statement. Mood disorders: pharmacological prevention ofrecurrence. Am J Psychiatry 1985; 142: 469–76
Frank E, Kupfer DJ, Wagner EF, et al. Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression: contributing factors. Arch Gen Psychiatry 1991; 48: 1053–9
Klerman GL, Weissman MM. The course, morbidity and costs of depression. Arch Gen Psychiatry 1992; 49: 831–4
Prien RF, Kupfer DJ. Continuation drug therapy for major depressive episodes: how long should it be maintained? Am J Psychiatry 1986; 143: 18–23
Schou M, Thomsen K, Baastrup PC. Studies on the course of recurrent endogenous affective disorders. Int Pharmacopsychiatry 1970; 5: 100–6
Montgomery SA. Failure to demonstrate prophylactic efficacy of dothiepin. Br J Psychiatry 1993; 163: 257–8
Kupfer DF, Frank E, Perel LM, et al. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1992; 49: 769–73
Baastrup PC, Poulsen IC, Schou M. Prophylactic lithium: double- blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet 1970; 2: 326–30
Montgomery SA, Dufour H, Brion S. The prophylactic effect of f1uoxetine in unipolar depression. Br J Psychiatry 1988; 153 Suppl. 3: 69–76
Montgomery SA, Rasmussen JGC, Tanghoi P. A 24-week study of 20mg citalopram, 40mg citalopram and placebo in the prevention of relapse of major depression. Int Clin Psychopharmacol 1993; 9: 181–8
Souêtre E, Martin P. Clinical economics and psychiatry. In: The use of f1uoxetine in clinical practice. Royal Society of Medicine Publications, 1991: 67–73
McGuire TG. Measuring the economic costs of schizophrenia. Schizophr Bull 1991; 17 (3): 375–88
Rice DP, Kelman S, Miller LS. Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Rep 1991; 103 (3): 280–92
McCombs JS, Nichol MB, Stimmel GL. The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a medical population. J Clin Psychiatry 1990; 51 (6 Suppl.): 60–9
Greenberg PE, Stiglin LE, Findelstein SN, et al. The economic burden of depression. J Clin Psychiatry 1993; 54: 405–18
Souêtre E. Arrêt de travail et depression: impact de la f1uoxetine. Therapie 1993; 48: 81–8
Souêtre E, Qing W, Hardens M. Methodological approaches to pharmacoeconomics. Fundam Clin Pharmacol 1994; 8: 101–7
Hertzman P. The economic costs of mental illness in Sweden 1975. Acta Psychiatr Scand 1983; 68: 359–67
Andrews G, Hall W, Goldstein G, et al. The economic costs of schizophrenia. Arch Gen Psychiatry 1985; 42: 537–43
Hay J, Ernst R. The economic costs of Alzheimer’s disease. Am J Public Health 1987; 77: 1169–75
Boston Consulting Group. The contribution of pharmaceutical companies. Boston: Boston Consulting Group, 1993: 149–50
Broadhead WE, Blazer DG, George LK, et al. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 1990; 264 (19): 2524–8
Schurman RA, Kramer PD, Mitchell JB. The hidden mental health network. Arch Gen Psychiatry 1985; 42: 89–94
Wells KB, Hays RD, Burnam MA, et al. Detection of depressive disorder for patients receiving prepaid or fee-for-service care. JAMA 1989; 262: 3298–302
Hatziandreu EJ, Brown RE, Revicki DA, et al. Cost utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin. PharmacoEconomics 1994; 5 (3): 249–64
Weinstein MC, Fineberg HY. Clinical decision analysis. Philadelphia (PA): WB Saunders Co., 1980: 228–65
Beck JR, Paulker SG. The Markov process in medical diagnosis. Med Decis Making 1983; 3 (4): 419–58
Jönsson B, Bebbington PE. What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. Br J Psychiatry 1994; 163: 92/94/1–10
Rosenberg C, Damsbo N, Fuglum E, et al. Citalopram and imipramine in the treatment of depressive patients in general practice: a Nordic multicentre clinical study. Int Clin Psychopharmacol 1994; 9 Suppl. 1: 41–8
BMA. Bewertungsmass-stab für kassenärtzliche Leistungen. Cologne: Deutscher Arzte-Verlag GmbH, 1993
Rote Liste 1993. Arzneimittelverzeichnis des BPI. Aulendorf/ Würtemberg: Edition Cantor Verlag für Medizin und Naturwissenschaften GmbH, 1993
DOK-8: AOK-Bundesverband, 1994 Apr 15: 256
Statistisches Jahrbuch für die Bundesrepublik Deutschland 1993. Kusterdingen: Verlag Metzler-Poeschel, 1993
Boyer W, Feighner JP. The financial implications of starting treatment with a selective serotonin reuptake inhibitor or tricyclic antidepressant in drug-naive depressed patients. In: Jonsson B, Rosenbaum J, editors. Health economics of depression. Chichester: Wiley, 1993: 65–76
Schubert F. Ontario guidelines for economic analysis of pharmaceutical products. Ottawa: Ministry of Health, Drug Programs Branch, 1993
Schubert F, editor. Proceedings of the Canadian Collaborative Workshop on Pharmacoeconomics. Princeton (NJ): Excerpta Medica, Inc., 1993
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nuijten, M.J.C., Hardens, M. & Souêtre, E. A Markov Process Analysis Comparing the Cost Effectiveness of Maintenance Therapy with Citalopram versus Standard Therapy in Major Depression. Pharmacoeconomics 8, 159–168 (1995). https://doi.org/10.2165/00019053-199508020-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199508020-00007