Pharmacoeconomics of antidepressants in moderate-to-severe depressive disorder in Colombia

Objective. To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. Methods. Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitrip-tyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of de-pression (a score ≤7 on the Hamilton Depression [HAM-D] scale or ≤12 on the Montgomery-Åsberg Depression Rating Scale [MADRS]) after 8 weeks of treatment. Clinical data were obtained from the literature and costs from standard Colombian price lists. One-way and multi-variate sensitivity analyses tested model robustness. Results. Costs per patient (in 2007 US$) for treatment were: venlafaxine, $1 618; fluoxe-tine, $1 207; and amitriptyline, $1 068. Overall remission rates were 73.1%, 64.1%, and 71.3%, respectively. Amitriptyline dominated fluoxetine (i.e., it had lower costs and higher outcomes). The incremental cost-effectiveness ratio (ICER) of venlafaxine over amitriptyline was US $ 31 595. The acquisition price of venlafaxine was the model’s cost driver, comprising 53.4 % of the total cost/patient treated, compared with 18.5 % and 24.8 % for fluoxetine an