Cost-effectiveness of escitalopram vs. citalopram in major depressive disorder

• Published in: International clinical psychopharmacology Vol. 22; no. 2; pp. 107 - 115
• Main Authors: Fantino, Bruno, Moore, Nicholas, Verdoux, Hélène, Auray, Jean-Paul
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-03-2007; Lippincott Williams & Wilkins
• Subjects: Adult; Adult and adolescent clinical studies; Antidepressive Agents, Second-Generation - economics; Antidepressive Agents, Second-Generation - therapeutic use; Biological and medical sciences; Citalopram - economics; Citalopram - therapeutic use; Cost-Benefit Analysis; Depression; Depressive Disorder, Major - drug therapy; Drug Costs; Drug Therapy - economics; Female; France; Health Care Costs; Hospital Costs; Humans; Male; Medical sciences; Middle Aged; Mood disorders; Neuropharmacology; Office Visits - economics; Pharmacology. Drug treatments; Psychiatric Status Rating Scales; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Randomized Controlled Trials as Topic; Treatment Outcome; France; Mood disorder; Human; cost-effectiveness; Serotonin; Escitalopram; Psychotropic; Controlled therapeutic trial; Depression; randomized clinical trial; Reuptake inhibitor; Selective serotonin reuptake inhibitor; Citalopram; Health economy; Neurotransmitter; Antidepressant agent; major depression; Cost efficiency analysis
• ISSN: 0268-1315; 1473-5857
• DOI: 10.1097/YIC.0b013e3280128d16

Clinical trials have shown better efficacy of escitalopram over citalopram, and review-based economic models the cost-effectiveness of escitalopram vs. citalopram (brand and generic). No head-to-head clinical trial has, however, evaluated the cost-effectiveness of both drugs so far. The aim of this study was to assess the relative cost-effectiveness of escitalopram compared with citalopram in patients with major depressive disorder. An economic evaluation was conducted alongside a double-blind randomized clinical trial conducted by general practitioners and psychiatrists comparing fixed doses of escitalopram (20 mg/day) or citalopram (40 mg/day) over 8 weeks in ambulatory care patients with major depressive disorder (baseline Montgomery–Åsberg Depression Rating Scale score ≥30). Resources use was recorded using a standardized form recording use of healthcare services and days of sick leave for the 2-month prestudy period and for the 8-week study period. Statistically significant improvements were observed in patients treated with escitalopram. Mean per-patient costs for the escitalopram group, compared with the citalopram group, were 41% lower (€96 vs. €163; P<0.05) from a healthcare perspective. Differences were mostly related to lower hospitalization costs for escitalopram compared with citalopram recipients, assuming a parity price between escitalopram and citalopram. Bootstrapped distributions of the cost-effectiveness ratios also showed better effectiveness and lower costs for escitalopram compared with citalopram. Escitalopram is significantly more effective than citalopram, and is associated with lower healthcare costs. This prospective economic analysis demonstrated that escitalopram is a cost-effective first-line treatment option for major depressive disorder.