Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: A six-month randomised study comparing fluoxetine to imipramine
Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of a...
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| Veröffentlicht in: | Journal of affective disorders 2006-04, Vol.91 (2), p.153-163 |
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| creator | Serrano-Blanco, A. Gabarron, E. Garcia-Bayo, I. Soler-Vila, M. Caramés, E. Peñarrubia-Maria, M.T. Pinto-Meza, A. Haro, J.M. |
| description | Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice.
A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter.
Of the 103 patients, 38.8% (
n
=
40) were diagnosed with major depressive disorder, 14.6% (
n
=
15) with dysthymic disorder, and 46.6% (
n
=
48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine €469.66 versus fluoxetine €1585.93 in major depressive disorder,
p
<
0.05; imipramine €175.39 versus fluoxetine €2929.36 in dysthymic disorder,
p
<
0.05). The group with depressive disorder
not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups.
Exclusion criteria, participating physicians may not represent GPs.
In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder
not otherwise specified. |
| doi_str_mv | 10.1016/j.jad.2005.11.014 |
| format | Article |
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A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter.
Of the 103 patients, 38.8% (
n
=
40) were diagnosed with major depressive disorder, 14.6% (
n
=
15) with dysthymic disorder, and 46.6% (
n
=
48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine €469.66 versus fluoxetine €1585.93 in major depressive disorder,
p
<
0.05; imipramine €175.39 versus fluoxetine €2929.36 in dysthymic disorder,
p
<
0.05). The group with depressive disorder
not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups.
Exclusion criteria, participating physicians may not represent GPs.
In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder
not otherwise specified.</description><identifier>ISSN: 0165-0327</identifier><identifier>EISSN: 1573-2517</identifier><identifier>DOI: 10.1016/j.jad.2005.11.014</identifier><identifier>PMID: 16458976</identifier><identifier>CODEN: JADID7</identifier><language>eng</language><publisher>Amsterdam: Elsevier B.V</publisher><subject>Adult ; Adult and adolescent clinical studies ; Antidepressants ; Antidepressive Agents, Tricyclic - economics ; Antidepressive Agents, Tricyclic - therapeutic use ; Biological and medical sciences ; Cost-Benefit Analysis ; Cost-effectiveness ; Depression ; Depressive Disorder, Major - drug therapy ; Depressive Disorder, Major - economics ; Double-Blind Method ; Female ; Fluoxetine - economics ; Fluoxetine - therapeutic use ; Follow-Up Studies ; Humans ; Imipramine - economics ; Imipramine - therapeutic use ; Major depressive disorder ; Male ; Medical sciences ; Mood disorders ; Neuropharmacology ; Pharmacology. Drug treatments ; Primary care ; Primary Health Care - economics ; Primary Health Care - methods ; Prospective Studies ; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychopharmacology ; Serotonin Uptake Inhibitors - economics ; Serotonin Uptake Inhibitors - therapeutic use</subject><ispartof>Journal of affective disorders, 2006-04, Vol.91 (2), p.153-163</ispartof><rights>2005 Elsevier B.V.</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-7b40e86e6a2d86c4252ff8f2e6055e90af73b8cef2dc55ddec14276fbaaa02b43</citedby><cites>FETCH-LOGICAL-c381t-7b40e86e6a2d86c4252ff8f2e6055e90af73b8cef2dc55ddec14276fbaaa02b43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jad.2005.11.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17654912$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16458976$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Serrano-Blanco, A.</creatorcontrib><creatorcontrib>Gabarron, E.</creatorcontrib><creatorcontrib>Garcia-Bayo, I.</creatorcontrib><creatorcontrib>Soler-Vila, M.</creatorcontrib><creatorcontrib>Caramés, E.</creatorcontrib><creatorcontrib>Peñarrubia-Maria, M.T.</creatorcontrib><creatorcontrib>Pinto-Meza, A.</creatorcontrib><creatorcontrib>Haro, J.M.</creatorcontrib><creatorcontrib>Depressió en Atenció Primària de Gavà group (D. A. P. G. A.)</creatorcontrib><creatorcontrib>Depressió en Atenció Primària de Gavà Group (D. A. P. G. A.)</creatorcontrib><title>Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: A six-month randomised study comparing fluoxetine to imipramine</title><title>Journal of affective disorders</title><addtitle>J Affect Disord</addtitle><description>Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice.
A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter.
Of the 103 patients, 38.8% (
n
=
40) were diagnosed with major depressive disorder, 14.6% (
n
=
15) with dysthymic disorder, and 46.6% (
n
=
48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine €469.66 versus fluoxetine €1585.93 in major depressive disorder,
p
<
0.05; imipramine €175.39 versus fluoxetine €2929.36 in dysthymic disorder,
p
<
0.05). The group with depressive disorder
not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups.
Exclusion criteria, participating physicians may not represent GPs.
In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder
not otherwise specified.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Antidepressants</subject><subject>Antidepressive Agents, Tricyclic - economics</subject><subject>Antidepressive Agents, Tricyclic - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cost-Benefit Analysis</subject><subject>Cost-effectiveness</subject><subject>Depression</subject><subject>Depressive Disorder, Major - drug therapy</subject><subject>Depressive Disorder, Major - economics</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Fluoxetine - economics</subject><subject>Fluoxetine - therapeutic use</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Imipramine - economics</subject><subject>Imipramine - therapeutic use</subject><subject>Major depressive disorder</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mood disorders</subject><subject>Neuropharmacology</subject><subject>Pharmacology. Drug treatments</subject><subject>Primary care</subject><subject>Primary Health Care - economics</subject><subject>Primary Health Care - methods</subject><subject>Prospective Studies</subject><subject>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychopharmacology</subject><subject>Serotonin Uptake Inhibitors - economics</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><issn>0165-0327</issn><issn>1573-2517</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxi0EokvhAbggX-CWxXZiOwunqip_pEpc4Gw59ph6lcTBdqr2Tfq4TLWRKi6cPDP-zefxfIS85WzPGVcfj_uj9XvBmNxzvme8e0Z2XOq2EZLr52SHjGxYK_QZeVXKkTGmDpq9JGdcdbI_aLUjD1chgKvxFmYohdrZU5dKbeCfcgp4U6OHJWOKIa0ZbJ0AozjTJcfJ5nt6A3asN9TZDJ_oBS3xrpnSjJWMummKBTwtdfX3-Ma02Bzn3zSMa7qDGmegNdE4xSXbCbPX5EWwY4E323lOfn25-nn5rbn-8fX75cV149qe10YPHYNegbLC98p1QooQ-iBAMSnhwGzQ7dA7CMI7Kb0HxzuhVRistUwMXXtOPpx0l5z-rFCqwTkdjKOdIa3FKK0V77VCkJ9Al1MpGYLZvm04M492mKNBO8yjHYZzg3Zgz7tNfB0m8E8d2_4ReL8Btjg7BlyUi-WJ00p2By6Q-3ziAFdxGyGb4iLMDnzM6JPxKf5njL9v5azN</recordid><startdate>20060401</startdate><enddate>20060401</enddate><creator>Serrano-Blanco, A.</creator><creator>Gabarron, E.</creator><creator>Garcia-Bayo, I.</creator><creator>Soler-Vila, M.</creator><creator>Caramés, E.</creator><creator>Peñarrubia-Maria, M.T.</creator><creator>Pinto-Meza, A.</creator><creator>Haro, J.M.</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060401</creationdate><title>Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: A six-month randomised study comparing fluoxetine to imipramine</title><author>Serrano-Blanco, A. ; Gabarron, E. ; Garcia-Bayo, I. ; Soler-Vila, M. ; Caramés, E. ; Peñarrubia-Maria, M.T. ; Pinto-Meza, A. ; Haro, J.M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-7b40e86e6a2d86c4252ff8f2e6055e90af73b8cef2dc55ddec14276fbaaa02b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Antidepressants</topic><topic>Antidepressive Agents, Tricyclic - economics</topic><topic>Antidepressive Agents, Tricyclic - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cost-Benefit Analysis</topic><topic>Cost-effectiveness</topic><topic>Depression</topic><topic>Depressive Disorder, Major - drug therapy</topic><topic>Depressive Disorder, Major - economics</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Fluoxetine - economics</topic><topic>Fluoxetine - therapeutic use</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Imipramine - economics</topic><topic>Imipramine - therapeutic use</topic><topic>Major depressive disorder</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mood disorders</topic><topic>Neuropharmacology</topic><topic>Pharmacology. Drug treatments</topic><topic>Primary care</topic><topic>Primary Health Care - economics</topic><topic>Primary Health Care - methods</topic><topic>Prospective Studies</topic><topic>Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychopharmacology</topic><topic>Serotonin Uptake Inhibitors - economics</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Serrano-Blanco, A.</creatorcontrib><creatorcontrib>Gabarron, E.</creatorcontrib><creatorcontrib>Garcia-Bayo, I.</creatorcontrib><creatorcontrib>Soler-Vila, M.</creatorcontrib><creatorcontrib>Caramés, E.</creatorcontrib><creatorcontrib>Peñarrubia-Maria, M.T.</creatorcontrib><creatorcontrib>Pinto-Meza, A.</creatorcontrib><creatorcontrib>Haro, J.M.</creatorcontrib><creatorcontrib>Depressió en Atenció Primària de Gavà group (D. A. P. G. A.)</creatorcontrib><creatorcontrib>Depressió en Atenció Primària de Gavà Group (D. A. P. G. A.)</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of affective disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Serrano-Blanco, A.</au><au>Gabarron, E.</au><au>Garcia-Bayo, I.</au><au>Soler-Vila, M.</au><au>Caramés, E.</au><au>Peñarrubia-Maria, M.T.</au><au>Pinto-Meza, A.</au><au>Haro, J.M.</au><aucorp>Depressió en Atenció Primària de Gavà group (D. A. P. G. A.)</aucorp><aucorp>Depressió en Atenció Primària de Gavà Group (D. A. P. G. A.)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: A six-month randomised study comparing fluoxetine to imipramine</atitle><jtitle>Journal of affective disorders</jtitle><addtitle>J Affect Disord</addtitle><date>2006-04-01</date><risdate>2006</risdate><volume>91</volume><issue>2</issue><spage>153</spage><epage>163</epage><pages>153-163</pages><issn>0165-0327</issn><eissn>1573-2517</eissn><coden>JADID7</coden><abstract>Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice.
A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter.
Of the 103 patients, 38.8% (
n
=
40) were diagnosed with major depressive disorder, 14.6% (
n
=
15) with dysthymic disorder, and 46.6% (
n
=
48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine €469.66 versus fluoxetine €1585.93 in major depressive disorder,
p
<
0.05; imipramine €175.39 versus fluoxetine €2929.36 in dysthymic disorder,
p
<
0.05). The group with depressive disorder
not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups.
Exclusion criteria, participating physicians may not represent GPs.
In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder
not otherwise specified.</abstract><cop>Amsterdam</cop><pub>Elsevier B.V</pub><pmid>16458976</pmid><doi>10.1016/j.jad.2005.11.014</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0165-0327 |
| ispartof | Journal of affective disorders, 2006-04, Vol.91 (2), p.153-163 |
| issn | 0165-0327 1573-2517 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_67761876 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Adult and adolescent clinical studies Antidepressants Antidepressive Agents, Tricyclic - economics Antidepressive Agents, Tricyclic - therapeutic use Biological and medical sciences Cost-Benefit Analysis Cost-effectiveness Depression Depressive Disorder, Major - drug therapy Depressive Disorder, Major - economics Double-Blind Method Female Fluoxetine - economics Fluoxetine - therapeutic use Follow-Up Studies Humans Imipramine - economics Imipramine - therapeutic use Major depressive disorder Male Medical sciences Mood disorders Neuropharmacology Pharmacology. Drug treatments Primary care Primary Health Care - economics Primary Health Care - methods Prospective Studies Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease) Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychopharmacology Serotonin Uptake Inhibitors - economics Serotonin Uptake Inhibitors - therapeutic use |
| title | Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: A six-month randomised study comparing fluoxetine to imipramine |
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