© 2001 The Royal College of Psychiatrists
Antidepressant selection and economic outcome: a review of methods and studies from clinical practice
The MEDSTAT Group, 125 Cambridge Park Drive, Cambridge, MA 02140, USA. Tel: + 1 617 492 9309; fax: + 1 617 492 9365
Correspondence: e-mail: Bill_Crown{at}MEDSTAT.com
Declaration of interest W.H.C. received an honorarium and travel expenses from Eli Lilly & Co.
Background Economic considerations increasingly play a role in the selection of antidepressant drugs and are often based on analyses from prospective and retrospective studies. However, the non-randomisation found in retrospective studies may result in significant selection bias.
Aims To highlight the use of statistical methods in non-randomised studies and the application of those methods to economic analyses.
Method The literature on the observational studies of economic outcomes with alternative antidepressants is reviewed and several statistical methodologies to control for biases that can occur in non-randomised study designs are described.
Results In comparisons of antidepressant drugs, differences in acquisition costs are consistently found to be at least offset by other components of care when broad measures of health care resource utilisation are considered.
Conclusions Economic evaluations of antidepressants should be based on broad measures of health care expenditure and can rely on data generated in real-world settings if appropriate statistical methods are used to control for the potential biases of non-randomisation.