, Volume 13, Issue 5, pp 543–561 | Cite as


A Pharmacoeconomic Review of its Use in Depression
Adis Pharmacoeconomic Drug Evaluation Fluoxetine: A Pharmacoeconomic Review


Depressive illness is a common, often unrecognised and untreated condition with substantial associated costs, particularly indirect costs (e.g. lost productivity and absenteeism).

The improved tolerability profile of fluoxetine and associated lower discontinuation rates, the relative safety of the drug in overdosage and its similar efficacy compared with tricyclic antidepressants have provided the main rationale for using this agent in depressed patients.

Pharmacoeconomic analyses of fluoxetine have mainly sought to determine whether its higher acquisition cost in comparison with tricyclic antidepressants can be offset by reductions in other costs and whether the use of this agent as first-line therapy can be justified. Studies have also attempted to determine whether the selective serotonin reuptake inhibitors (SSRIs) can be distinguished from one another on pharmacoeconomic grounds; overall efficacy and tolerability of these agents appear to be similar, although tolerability data are conflicting.

Most analyses have been of a retrospective database or clinical decision analytic model design; two prospective trials (one conducted in a naturalistic setting) have been conducted. These studies have mainly considered direct treatment costs only from the perspective of the healthcare payer.

Available evidence suggests that overall total direct healthcare costs for patients who start antidepressant therapy with fluoxetine are similar to, or lower than, those for patients who start therapy with tricyclic agents or other SSRIs.

Offsetting of the higher acquisition cost of fluoxetine compared with that of tricyclic agents may be accounted for by lower in- and outpatient costs with fluoxetine, a possible lower risk of absenteeism from work and lower mean total medical costs associated with acute overdosage. Between-treatment differences in drug use patterns may also, in part, explain the observed differences in total healthcare costs between fluoxetine and other antidepressants. In particular, patients beginning therapy with fluoxetine are more likely to receive treatment regimens that meet minimum recommended guidelines for dosage and duration and are less likely to require treatment switching/augmentation than those receiving tricyclic antidepressants or other SSRIs as initial therapy. In addition, fewer fluoxetine than tricyclic antidepressant recipients discontinue therapy early, and fewer fluoxetine recipients require upward dosage titration or concomitant anxiolytic/ hypnotic medications than patients receiving other SSRIs.

In conclusion, fluoxetine is a well established antidepressant which possesses tolerability and safety advantages over the tricyclic agents. The available cost analyses show that these benefits can be obtained without additional overall cost to the healthcare provider. Cost advantages observed to date for fluoxetine over other SSRIs require confirmation.


Adis International Limited Fluoxetine Paroxetine Sertraline Moclobemide 
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  1. 1.
    Woods SW, Baker CB. Cost-effectiveness of newer antidepressants. Curr Opin Psychiatry 1997 Mar; 10: 95–101CrossRefGoogle Scholar
  2. 2.
    Hotopf M, Lewis G, Normand C. Are SSRIs a cost-effective alternative to tricyclics? Br J Psychiatry 1996 Apr; 168: 404–9PubMedCrossRefGoogle Scholar
  3. 3.
    Henry JA, Rivas CA. Constraints on antidepressant prescribing and principles of cost-effective antidepressant use. Part 1: depression and its treatment. Pharmacoeconomics 1997 May; 11: 419–43PubMedCrossRefGoogle Scholar
  4. 4.
    Greenberg PE, Stiglin LE, Finkelstein SN, et al. Depression: a neglected major illness. J Clin Psychiatry 1993 Nov; 54: 419–24PubMedGoogle Scholar
  5. 5.
    Henry JA. Debits and credits in the management of depression. Br J Psychiatry 1993 Jul; 163 Suppl. 20: 33–9Google Scholar
  6. 6.
    Kind P, Sorensen J. The costs of depression. Int Clin Psychopharmacol 1993 Jan; 7: 191–5PubMedCrossRefGoogle Scholar
  7. 7.
    Jönsson B, Bebbington PE. What price depression? The cost of depression and the cost—effectiveness of pharmacological treatment. Br J Psychiatry 1994 May; 164: 665–73PubMedCrossRefGoogle Scholar
  8. 8.
    Wittchen H-Y, Knäuper B, Kessler RD. Lifetime risk of depression. Br J Psychiatry 1994; 165 Suppl. 26: 16–22Google Scholar
  9. 9.
    Kessler RC, McGonagle KA, Nelson CB, et al. Sex and depression in the National Comorbidity Survey II: cohort effects. J Affect Disord 1994; 30: 15–26PubMedCrossRefGoogle Scholar
  10. 10.
    Lehtinen V, Joukamaa M. Epidemiology of depression: prevalence, risk factors and treatment situation. Acta Psychiatr Scand 1994; 89 Suppl. 377: 7–10CrossRefGoogle Scholar
  11. 11.
    Weissman MM, Bland R, Joyce PR, et al. Sex differences in rates of depression: cross-national perspectives. J Affect Disord 1993 Oct—Nov; 29: 77–84PubMedCrossRefGoogle Scholar
  12. 12.
    Kessler RC, McGonagle KA, Swartz M, et al. Sex and depression in the National Comorbidity Survey I: lifetime prevalence, chronicity and recurrence. J Affect Disord 1993; 29: 85–96PubMedCrossRefGoogle Scholar
  13. 13.
    MacDonald TM, McMahon AD, Reid IC. Antidepressant drug use in primary care: a record linkage study in Tayside, Scotland. BMJ 1996 Oct 5; 313: 860–1PubMedCrossRefGoogle Scholar
  14. 14.
    Donoghue JM, Tylee A. The treatment of depression: prescribing patterns of antidepressants in primary care in the UK. Br J Psychiatry 1996 Feb; 168: 164–8PubMedCrossRefGoogle Scholar
  15. 15.
    Katon W, Von Korff M, Lin E, et al. Adequacy and duration of antidepressant treatment in primary care. Med Care 1992; 30: 67–76PubMedCrossRefGoogle Scholar
  16. 16.
    Santiago JM. The costs of treating depression. J Clin Psychiatry 1993 Nov; 54: 425–6PubMedGoogle Scholar
  17. 17.
    McCombs JS, Nichol MB, Stimmel GL, et al. The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a medicaid population. J Clin Psychiatry 1990; 51 Suppl.: 60–9Google Scholar
  18. 18.
    Spaner D, Bland RC, Newman SC. Major depressive disorder. Acta Psychiatr Scand 1994; 376 Suppl.: 7–15CrossRefGoogle Scholar
  19. 19.
    Angst J. Epidemiology of depression. Psychopharmacology 1992; 106 Suppl.: S71–4CrossRefGoogle Scholar
  20. 20.
    Hale AS. Juggling cost and benefit in the long-term treatment of depression. Postgrad Med J 1994; 70 Suppl. 2: S2–8Google Scholar
  21. 21.
    Maynard A. Cost management: the economist’s viewpoint. Br J Psychiatry 1993 Jul; 163 Suppl. 20: 7–13Google Scholar
  22. 22.
    Katzelnick DJ, Kobak KA, Jefferson JW, et al. Prescribing patterns of antidepressant medications for depression in a HMO. Formulary 1996; 31: 374–88Google Scholar
  23. 23.
    Greenberg PE, Stiglin LE, Finkelstein SN, et al. The economic burden of depression in 1990. J Clin Psychiatry 1993 Nov; 54: 405–18PubMedGoogle Scholar
  24. 24.
    Hylan TR, Buesching DP, Tollefson GD. Health economic evaluations of antidepressants: a review. Depression Anxiety. In pressGoogle Scholar
  25. 25.
    Bingefors K, Isacson D, von Knorring L. Antidepressant dose patterns in Swedish clinical practice. Int Clin Psychopharmacol 1997; 12: 283–90PubMedCrossRefGoogle Scholar
  26. 26.
    Saklad SR. Pharmacoeconomic issues in the treatment of depression. Pharmacotherapy 1995 Nov—Dec; 15 (Pt 2): 76S–83SPubMedGoogle Scholar
  27. 27.
    Lane R, McDonald G. Reducing the economic burden of depression. Int Clin Psychopharmacol 1994 Winter; 9: 229–43PubMedCrossRefGoogle Scholar
  28. 28.
    Rupp A, Narrow W, Regier D, et al. Epidemiology and costs of depression: a hidden burden. Dis Manage Health Outcomes 1997 Sep; 2: 134–40CrossRefGoogle Scholar
  29. 29.
    Henry JA, Rivas CA. Constraints on antidepressant prescribing and principles of cost-effective antidepressant use. Part 2: Cost effectiveness analysis. Pharmacoeconomics 1997 Jun; 11: 515–37PubMedCrossRefGoogle Scholar
  30. 30.
    Judd LL, Paulus MP, Wells KB, et al. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry 1996 Nov; 153: 1411–7PubMedGoogle Scholar
  31. 31.
    Franco K, Tamburino M, Campbell N, et al. The added costs of depression to medical care. Pharmacoeconomics 1995 Apr; 7: 284–91PubMedCrossRefGoogle Scholar
  32. 32.
    Stoudemire A, Frank R, Hedemark N. The economic burden of depression. Gen Hosp Psychiatry 1986 Nov; 8: 387–94PubMedCrossRefGoogle Scholar
  33. 33.
    Rupp A. The economic consequences of not treating depression. Br J Psychiatry 1995; 166 Suppl. 27: 29–33Google Scholar
  34. 34.
    Lewis-Hall FC, Wilson MG, Tepner RG, et al. Fluoxetine vs. tricyclic antidepressants in women with major depressive disorder. J Women Health 1997 Jun; 6: 337–43CrossRefGoogle Scholar
  35. 35.
    Benfield P, Heel RC, Lewis SP. Fluoxetine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. Drugs 1986 Dec; 32: 481–508PubMedCrossRefGoogle Scholar
  36. 36.
    Anderson IM, Tomenson BM. Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. BMJ 1995 Jun 3; 310: 1433–8PubMedCrossRefGoogle Scholar
  37. 37.
    Edwards JG. Drug choice in depression: selective serotonin reuptake inhibitors or tricyclic antidepressants? CNS Drugs 1995 Aug; 4: 141–59CrossRefGoogle Scholar
  38. 38.
    Steffens DC, Krishnan RR, Helms MJ. Are SSRIs better than TCAs? Comparison of SSRIs and TCAs: a meta-analysis. Depression Anxiety 1997; 6: 10–8CrossRefGoogle Scholar
  39. 39.
    Montgomery SA, Henry J, McDonald G, et al. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol 1994; 9 (1): 47–53PubMedCrossRefGoogle Scholar
  40. 40.
    Rudorfer MV, Manji HK, Potter WZ. Comparative tolerability profiles of the newer versus older antidepressants. Drug Saf 1994 Jan; 10: 18–46PubMedCrossRefGoogle Scholar
  41. 41.
    Simon GE, VonKorff M, Heiligenstein JH, et al. Initial antidepressant choice in primary care: effectiveness and cost of fluoxetine vs tricyclic antidepressants. JAMA 1996 Jun 26; 275: 1897–902PubMedCrossRefGoogle Scholar
  42. 42.
    Le Pen C, Levy E, Ravily V, et al. The cost of treatment dropout in depression. A cost-benefit analysis of fluoxetine vs. tricyclics. J Affect Disord 1994; 31: 1–18PubMedCrossRefGoogle Scholar
  43. 43.
    Kernick DP. Which antidepressant? A commentary from general practice on evidence based medicine and health economics. Br J Gen Pract 1997 Feb; 47: 95–8PubMedGoogle Scholar
  44. 44.
    de Jonghe F, Swinkels J. Selective serotonin reuptake inhibitors: relevance of differences in their pharmacological and clinical profiles. CNS Drugs 1997; 7 (6): 452–67CrossRefGoogle Scholar
  45. 45.
    Aguglia E, Casacchia M, Cassano GB, et al. Double-blind study of the efficacy and safety of sertraline versus fluoxetine in major depression. Int Clin Psychopharmacol 1993; 8 (3): 197–202PubMedCrossRefGoogle Scholar
  46. 46.
    MacKay FJ, Dunn NR, Wilton LV, et al. A comparison of fluvoxamine, fluoxetine, sertraline and paroxetine examined by observational cohort studies. Pharmacoepidemiol Drug Saf 1997; 6: 235–46PubMedCrossRefGoogle Scholar
  47. 47.
    Fisher S, Kent TA, Bryant SG. Postmarketing surveillance by patient self-monitoring: preliminary data for sertraline versus fluoxetine. J Clin Psychiatry 1995 Jul; 56: 288–96PubMedGoogle Scholar
  48. 48.
    Wilde MI, Whittington R. Paroxetine: a pharmacoeconomic evaluation of its use in depression. Pharmacoeconomics 1995 Jul; 8: 62–81PubMedCrossRefGoogle Scholar
  49. 49.
    Thompson D, Buesching D, Gregor KJ, et al. Patterns of antidepressantuse and their relation to costs of care. Am J Manage Care 1996; 2: 1239–46Google Scholar
  50. 50.
    Modell JG, Katholi CR, Modell JD, et al. Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther 1997 Apr; 61: 476–87PubMedCrossRefGoogle Scholar
  51. 51.
    Harris MG, Benfield P. Fluoxetine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in older patients with depressive illness. Drugs Aging 1995 Jan; 6: 64–84PubMedCrossRefGoogle Scholar
  52. 52.
    Pande AC, Sayler ME. Severity of depression and response to fluoxetine. Int Clin Psychopharmacol 1993; 8 (4): 243–5PubMedCrossRefGoogle Scholar
  53. 53.
    Song F, Freemantle N, Sheldon TA, et al. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ 1993; 306: 683–7PubMedCrossRefGoogle Scholar
  54. 54.
    Stokes PE. Fluoxetine: a five-year review. Clin Ther 1993 Mar—Apr; 15: 216–43PubMedGoogle Scholar
  55. 55.
    Lane R, Baldwin D, Preskorn S. The SSRIs: advantages, disadvantages and differences. J Psychopharmacol 1995; 9 (2) Suppl.: 163–78PubMedGoogle Scholar
  56. 56.
    Miller FT, Freilicher J. Comparison of TCAs and SSRIs in the treatment of major depression in hospitalized geriatric patients. J Geriatr Psychiatry Neurol 1995 Jul; 8: 173–6PubMedGoogle Scholar
  57. 57.
    Smith HA, Wedlund PJ. Depression: its classification, epidemiology, expression and treatment. J Pharmacoepidemiol 1993; 2: 3–34CrossRefGoogle Scholar
  58. 58.
    Tignol J. A double-blind, randomized, fluoxetine-controlled, multicenter study of paroxetine in the treatment of depression. J Clin Psychopharmacol 1993 Dec; 13 Suppl. 2: 18S–22SGoogle Scholar
  59. 59.
    De WJ, Spiers R, Mertens C, et al. A double-blind, comparative, multicentre study comparing paroxetine with fluoxetine in depressed patients. Acta Psychiatr Scand 1993 Feb; 87: 141–5CrossRefGoogle Scholar
  60. 60.
    Patris M, Bouchard J-M, Bougerol T, et al. Citalopram versus fluoxetine: a double-blind, controlled, multicentre, phase III trial in patients with unipolar major depression treated in general practice. Int Clin Psychopharmacol 1996 Jun; 11: 129–36PubMedGoogle Scholar
  61. 61.
    Rapaport M, Coccaro E, Sheline Y, et al. A comparison of fluvoxamine and fluoxetine in the treatment of major depression. J Clin Psychopharmacol 1996 Oct; 16: 373–8PubMedCrossRefGoogle Scholar
  62. 62.
    Noble S, Benfield P. Citalopram: a review of its pharmacology, clinical efficacy and tolerability in the treatment of depression. CNS Drugs 1997; 8 (5): 410–31CrossRefGoogle Scholar
  63. 63.
    Schöne W, Ludwig M. A double—blind study of paroxetine compared with fluoxetine in geriatric patients with major depression. J Clin Psychopharmacol 1993 Dec; 13 Suppl. 2: 34S–9SGoogle Scholar
  64. 64.
    Geretsegger C, Böhmer F, Ludwig M. Paroxetine in the elderly depressed patient: randomized comparison with fluoxetine of efficacy, cognitive and behavioural effects. Int Clin Psychopharmacol 1994; 9 (1): 25–9PubMedCrossRefGoogle Scholar
  65. 65.
    Trindale E, Menon D. Selective serotonin reuptake inhibitors (SSRIS) for major depression. Part I. Evaluation of the clinical literature. Canadian Co-ordinating Office for Health Technology Assessment. Report 1997: 3EGoogle Scholar
  66. 66.
    Finley PR. Selective serotonin reuptake inhibitors: pharmacologic profiles and potential therapeutic distinctions. Ann Pharmacother 1994; 28: 1359–69PubMedGoogle Scholar
  67. 67.
    Donovan S, McGrady H, Pownall R. The efficacy and tolerability of dothiepin and three selective serotonin reuptake inhibitors in the treatment of major depression: a review of six double-blind studies. Curr Ther Res 1993 Sep; 54: 275–89CrossRefGoogle Scholar
  68. 68.
    Robertson MM, Abou-Saleh MT, Harrison DA, et al. A doubleblind controlled comparison of fluoxetine and lofepramine in major depressive illness. J Psychopharmacol 1994; 8 (2): 98–103PubMedCrossRefGoogle Scholar
  69. 69.
    Lapierre YD, Joffe R, McKenna K, et al. Moclobemide versus fluoxetine in the treatment of major depressive disorder in adults. J Psychiatry Neurosci 1997 Mar; 22: 118–26PubMedGoogle Scholar
  70. 70.
    Fulton B, Benfield P. Moclobemide: an update of its pharmacological properties and therapeutic use. Drugs 1996; 52 (3): 450–74PubMedCrossRefGoogle Scholar
  71. 71.
    La Pia S, Giorgio D, Ciriello R, et al. Evaluation of the efficacy, tolerability, and therapeutic profile of fluoxetine versus mianserin in the treatment of depressive disorders in the elderly. Curr Ther Res 1992; 52 (6): 847–58CrossRefGoogle Scholar
  72. 72.
    Haria M, Fitton A, McTavish D. Trazodine: a review of its pharmacology, therapeutic use in depression and therapeutic potential in other disorders. Drugs Aging 1994; 4 (4): 331–55PubMedCrossRefGoogle Scholar
  73. 73.
    Holliday SM, Benfield P. Venlafaxine: a review of its pharmacology and therapeutic potential in depression. Drugs 1995; 49 (2): 280–94PubMedCrossRefGoogle Scholar
  74. 74.
    Dierick M, Ravizza L, Realini R. A double-blind comparison of venlafaxine and fluoxetine for treatment of major depression in outpatients. Prog Neuropsych Biol Psychiatry 1996 Jan; 20: 57–71CrossRefGoogle Scholar
  75. 75.
    Davis R, Whittington R, Bryson HM. Nefazodone: a review of its pharmacology and clinical efficacy in the management of major depression. Drugs 1997 Apr; 53: 608–36PubMedCrossRefGoogle Scholar
  76. 76.
    Rascati K. Drug utilization review of concomitant use of specific serotonin reuptake inhibitors or clomipramine with antianxiety/ sleep medications. Clin Ther 1995 Jul—Aug; 17: 786–90PubMedCrossRefGoogle Scholar
  77. 77.
    Hylan TR, Neslusan CA, Baldridge M, et al. SSRI antidepressant selection and anxiolytic and sedative-hypnotic use. J Clin Outcomes Manage 1997 Jul—Aug; 4: 16–22Google Scholar
  78. 78.
    Gregor KJ, Riley JA, Downing DK. Concomitant use of anxiolytics and hypnotics with selective serotonin reuptake inhibitors. Clin Ther 1996 May—Jun; 18: 521–7PubMedCrossRefGoogle Scholar
  79. 79.
    Navarro R, Valler WE, Spangler M. Antidepressant utilization in managed care: an evaluation of SSRI use in two HMO settings. Medical Interface 1995; 8: 114–23PubMedGoogle Scholar
  80. 80.
    Pathiyal A, Hylan TR, Jones JK, et al. Prescribing of selective serotonin reuptake inhibitors, anxiolytics, and sedative-hypnotics by general practitioners in the Netherlands: a multivariate analysis. Clin Ther 1997; 19 (4): 798–810PubMedCrossRefGoogle Scholar
  81. 81.
    Preskorn S. Targeted pharmacotherapy in depression management: comparative pharmacokinetics of fluoxetine, paroxetine and sertraline. Int Clin Psychopharmacol 1994 Jun; 9 Suppl. 3: 13–9CrossRefGoogle Scholar
  82. 82.
    Sproule BA, Narnajo CA, Bremmer KE, et al. Selective serotonin reuptake inhibitors and CNS drug interactions. Clin Pharmacokinet 1997; 33 (6): 454–71PubMedCrossRefGoogle Scholar
  83. 83.
    Stahl MMS, Lindquist M, Pettersson M, et al. Withdrawal reactions with selective serotonin re-uptake inhibitors as reported to the WHO system. Eur J Clin Pharmacol 1997; 53: 163–9PubMedCrossRefGoogle Scholar
  84. 84.
    Stokes PE, Holtz A. Fluoxetine tenth anniversary update: the progress continues. Clin Ther 1997; 19 (5): 1135–250PubMedCrossRefGoogle Scholar
  85. 85.
    Hoog SL, Fava M, Ascroft RC, et al. Risk of adverse events and depressive symptom breakthrough following brief interruption of selective serotonin reuptake inhibitor therapy in a randomized clinical trial. Indianapolis: Eli Lilly, 1998. (Data on file)Google Scholar
  86. 86.
    Blomgren SL, Krebs W, Wilson M, et al. SSRI dose interruption study: interim data [abstract no. NR188]. 150th Annual Meeting of the American Psychiatric Association; 1997 May 17- 24; 118, San Diego, CaliforniaGoogle Scholar
  87. 87.
    Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995; 310: 215–8PubMedCrossRefGoogle Scholar
  88. 88.
    Feighner JP. Compliance and quality of response are major contributors to cost-effective antidepressant therapy. Hum Psychopharm 1994 Jun; 9 Suppl. 1: S21–23CrossRefGoogle Scholar
  89. 89.
    Buesching DP. The health economics mosaic: reviewing and organizing pharmacoeconomic data for antidepressant selection decisions. Indianapolis: Eli Lilly, 1998. (Data on file)Google Scholar
  90. 90.
    Mitchell J, Greenberg J, Finch K, et al. Effectiveness and economic impact of antidepressant medications: a review. Am J Manage Care 1997; 3: 323–30Google Scholar
  91. 91.
    Tracey D. Selective serotonin reuptake inhibitors: commercial interests should not influence prescribing [letter]. BMJ 1994 Oct 22; 309: 1083–4PubMedGoogle Scholar
  92. 92.
    World Health Organization Mental Health Collaborating Centers. Pharmacotherapy of depressive disorders: WHO consensus statement. J Affect Disord 1989; 17: 197–8Google Scholar
  93. 93.
    Agency for Health Care Policy Research. Treatment of major depression: clinical practice guidelines, no. 5, vol 2. Rockville (MD): US Department of Health and Human Services, AHCPR Publication no. 93-0550, 1993Google Scholar
  94. 94.
    American Psychiatric Association. Practice guideline for major depressive disorder in adults. Am J Psychiatry 1993; 150 Suppl. 4: 1–26Google Scholar
  95. 95.
    Montgomery SA, Bebbington P, Cowen P, et al. Guidelines for treating depressive illness with antidepressants: a statement from the British Association for Psychopharmacology. J Psychopharmacol 1993; 7 (1): 19–23PubMedGoogle Scholar
  96. 96.
    Revicki DA, Luce BR. Pharmacoeconomics research applied to psychopharmacology development and evaluation. Psychopharmacol Bull 1995; 31 (1): 57–65PubMedGoogle Scholar
  97. 97.
    Hylan TR, Kotsanos JG, Andersen JS, et al. Comparison of a decision analytic model with results from a naturalistic economic clinical trial: an application to evaluating alternative antidepressants. Am J Manage Care 1996; 2: 1211–23Google Scholar
  98. 98.
    Freemantle N, House A, Mason J, et al. Economics of treatment of depression [letter]. Br J Psychiatry 1995; 166. 397PubMedCrossRefGoogle Scholar
  99. 99.
    Croghan TW, Lair TJ, Engelhart L, et al. Effect of antidepressant therapy on health care utilization and costs in primary care. Psychiatr Serv 1997; 48: 1420–6PubMedGoogle Scholar
  100. 100.
    Hylan TR, Crown WH, Meneades L, et al. Tricyclic antidepressant and selective serotonin reuptake inhibitors antidepressant selection and health care costs in the naturalistic setting: a multivariate analysis. J Affect Disord 1998; 47: 71–9PubMedCrossRefGoogle Scholar
  101. 101.
    Crown WH, Obenchain RL, Englehart L, et al. The application of sample selection models to outcomes research: the case of evaluating the effects of antidepressant therapy on resource utilization. Stat Med. In pressGoogle Scholar
  102. 102.
    Woods SW, Rizzo JA. Cost-effectiveness of antidepressant treatment reassessed. Br J Psychiatry 1997 Mar; 170: 257–63PubMedCrossRefGoogle Scholar
  103. 103.
    Freemantle N, House A, Song F, et al. Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide. BMJ 1994 Jul 23; 309: 249–53PubMedCrossRefGoogle Scholar
  104. 104.
    Boyer WF, Feighner JP. The financial implications of starting treatment with a selective serotonin reuptake inhibitor or tricyclic antidepressant in drug-naive depressed patients. In: Jönsson B, Rosenbaum, J, editors. Health economics or depression. Chichester: Wiley, 1993: 65–75Google Scholar
  105. 105.
    Sclar DA, Robison LM, Skaer TL, et al. Antidepressant pharmacotherapy: economic outcomes in a health maintenance organization. Clin Ther 1994 Jul—Aug; 16: 715–30PubMedGoogle Scholar
  106. 106.
    Skaer TL, Sclar DA, Robison LM, et al. Antidepressant pharmacotherapy: effect on women’s resource utilization within a health maintenance organization. J Appl Ther 1996; 1: 45–52Google Scholar
  107. 107.
    Sclar DA, Skaer TL, Robison LM, et al. Economic outcomes with antidepressant pharmacotherapy: a retrospective intentto—treat analysis. (Data on file)Google Scholar
  108. 108.
    Simon GE, Fishman P. Cost implications of initial antidepressant selection in primary care. Pharmacoeconomics 1998; 13 (1 Pt 1): 61–70PubMedCrossRefGoogle Scholar
  109. 109.
    Venturini F, Hay JW. Cost-effectiveness analysis of fluoxetine versus amitriptyline as initial treatment of a major depressive episode in primary care [abstract]. Am J Manage Care 1997 Mar; 3: S25Google Scholar
  110. 110.
    Souêtre E, Lozet H, Cimarosti I. Predicting factors for absenteeism in patients with major depressive disorders. Eur J Epidemiol 1997 Jan; 13: 87–93PubMedCrossRefGoogle Scholar
  111. 111.
    Beuzen JN, Ravily VF, Souetre EJ, et al. Impact of fluoxetine on work loss in depression. Int Clin Psychopharmacol 1993; 8 (4): 319–21PubMedCrossRefGoogle Scholar
  112. 112.
    Melfi CA, Chawla AJ, Croghan TW, et al. The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Indianapolis: Eli Lilly, 1998. (Data on file)Google Scholar
  113. 113.
    Obenchain RL, Melfi CA, Croghan TW, et al. Bootstrap analyses of cost effectiveness in antidepressant pharmacotherapy. Pharmacoeconomics 1997 May; 11: 464–72PubMedCrossRefGoogle Scholar
  114. 114.
    Revicki DA, Palmer CS, Phillips SD, et al. Acute medical costs of fluoxetine versus tricyclic antidepressants: a prospective multicentre study of antidepressant drug overdoses. Pharmacoeconomics 1997 Jan; 11: 48-55Google Scholar
  115. 115.
    Sclar DA, Robison LM, Skaer TL, et al. Antidepressant pharmacotherapy: economic evaluation of fluoxetine, paroxetine and sertraline in a health maintenance organization. J Int Med Res 1995 Nov—Dec; 23: 395–412PubMedGoogle Scholar
  116. 116.
    Boyer P, Danion JM, Bisserbe JC, et al. Clinical and economic comparison of sertraline and fluoxetine in the treatment of depression. A 6-month double-blind study in a primary-care setting in France. Pharmacoeconomics 1998; 13 (1): 157–69PubMedCrossRefGoogle Scholar
  117. 117.
    Hylan TR, Crown WH, Meneades L, et al. Tricyclic and SSRI antidepressant drug use patterns in the naturalistic setting: a multivariate analysis. Indianapolis: Eli Lilly, 1998. (Data on file)Google Scholar
  118. 118.
    Donoghue JM. A comparison of prescribing patterns of selective serotonin reuptake inhibitors in the treatment of depression in primary care in the United Kingdom. J Serotonin Res 1995; 1: 47–51Google Scholar
  119. 119.
    Donoghue JM. Prescribing patterns of selective serotonin reuptake inhibitors in primary care: a naturalistic follow up study. J Serotonin Res 1996; 4: 267–70Google Scholar
  120. 120.
    Gregor KJ, Overhage JM, Coons SJ, et al. Selective serotonin reuptake inhibitor dose titration in the naturalistic setting. Clin Ther 1994 Mar—Apr; 16 (2): 306–15PubMedGoogle Scholar
  121. 121.
    Hylan TR, Dossenbach M, Meneades L, et al. Antidepressant use in the psychiatrist setting in Austria: a comparison of citalopram, fluoxetine, and paroxetine. J Serotonin Res. In pressGoogle Scholar
  122. 122.
    Hylan TR, Meneades L, Crown WH, et al. SSRI antidepressant use patterns and their relation to clinical global impressions scores: a naturalisatic study. Indianapolis: Eli Lilly, 1998. (Data on file)Google Scholar
  123. 123.
    Sclar DA, Skaer TL, Robison LM, et al. Evidence—based algorithm for antidepressant pharmacotherapy. (Data on file)Google Scholar
  124. 124.
    Revicki DA, Brown RE, Palmer W, et al. Modelling the cost effectiveness of antidepressant treatment in primary care. Pharmacoeconomics 1995 Dec; 8: 524–40PubMedCrossRefGoogle Scholar
  125. 125.
    Revicki DA, Brown RE, Keller MB, et al. Cost-effectiveness of newer antidepressants compared with tricyclic antidepressants in managed care settings [abstract]. J Clin Psychiatry 1997 Feb; 58: 47–58PubMedCrossRefGoogle Scholar
  126. 126.
    Anton SF, Revicki DA. The use of decision analysis in the pharmacoeconomic evaluation of an antidepressant: a costeffectiveness study of nefazodone. Psychopharmacol Bull 1995; 31 (2): 249–58PubMedGoogle Scholar
  127. 127.
    Lonnqvist J, Sintonen H, Syvälahti E, et al. Antidepressant efficacy and quality of life in depression: a double-blind study with moclobemide and fluoxetine. Acta Psychiatr Scand 1994 Jun; 89: 363–9PubMedCrossRefGoogle Scholar
  128. 128.
    Mesters P, Cosyns P, Dejaiffe G, et al. Assessment of quality of life in the treatment of major depressive disorder with fluoxetine,20 mg, in ambulatory patients aged over 60 years. Int Clin Psychopharmacol 1993; 8 (4): 337–40PubMedCrossRefGoogle Scholar
  129. 129.
    Heiligenstein JH, Ware JE, Beusterien KM, et al. Acute effects of fluoxetine versus placebo on functional health and wellbeing in late-life depression. Int Psychogeriatr 1995; 7 Suppl.: 125–37CrossRefGoogle Scholar
  130. 130.
    Souêtre E, Martin P, Lozet H, et al. Quality of life in depressed patients: comparison of fluoxetine and major tricyclic antidepressants. Int Clin Psychopharmacol 1996 Mar; 11: 45–52PubMedCrossRefGoogle Scholar

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© Adis International Limited 1998

Authors and Affiliations

  1. 1.Adis International LimitedMairangi Bay, Auckland 10New Zealand

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