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Cost Utility of Maintenance Treatment of Recurrent Depression with Sertraline Versus Episodic Treatment with Dothiepin

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Summary

The objective of this study was to model, for patients at risk of recurrent depression, the cost-utility of maintenance therapy with sertraline compared with treatment of acute episodes with dothiepin (‘episodic treatment’). Using clinical decision analysis techniques, a Markov state-transition model was constructed to estimate the lifetime costs and quality-adjusted life-years (QALYs) of the 2 therapeutic strategies. The model follows 2 cohorts of 35-year-old women at high risk for recurrent depression over their lifetimes. Model construction and relevant data (probabilities) for performing the analysis were based on existing clinical knowledge. Two physician panels were used to obtain estimates of recurrence probabilities not available in the literature, health utilities, and resource consumption. Costs were obtained from published sources. The baseline analysis showed that it costs £2172 ($US3692, 1991 currency) to save an additional QALY with sertraline maintenance treatment. Sensitivity analysis showed that the incremental cost-utility ratio ranged from £557 to £5260 per QALY. Overall, the resulting ratios are considered to be well within the range of cost-utility ratios that support the adoption and appropriate utilisation of a technology. Based on the study assumptions, long term maintenance treatment with sertraline appears to be clinically and economically justified choice for patients at high risk of recurrent depression.

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Authors and Affiliations

  1. Battelle Medical Technology Assessment and Policy (MEDTAP) Research Centers, Washington, DC, USA

    Evridiki J. Hatziandreu, Ruth E. Brown & Dennis A. Revicki

  2. Pfizer Central Research, Groton, Connecticut, USA

    Ralph Turner

  3. Pfizer International, Pharmaceuticals Group, New York, New York, USA

    Jacqueline Martindale

  4. Royal Oldham Hospital, Manchester, England

    Sydney Levine

  5. Harvard School of Public Health, Boston, Massachusetts, USA

    Joanna E. Siegel

  6. Battelle Medical Technology Assessment and Policy (MEDTAP) Research Centers, London, England

    Evridiki J. Hatziandreu, Ruth E. Brown & Dennis A. Revicki

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  1. Evridiki J. Hatziandreu
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  2. Ruth E. Brown
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  3. Dennis A. Revicki
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  4. Ralph Turner
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  5. Jacqueline Martindale
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  6. Sydney Levine
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  7. Joanna E. Siegel
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Hatziandreu, E.J., Brown, R.E., Revicki, D.A. et al. Cost Utility of Maintenance Treatment of Recurrent Depression with Sertraline Versus Episodic Treatment with Dothiepin. Pharmacoeconomics 5, 249–264 (1994). https://doi.org/10.2165/00019053-199405030-00008

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  • DOI: https://doi.org/10.2165/00019053-199405030-00008

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