The British Journal of Psychiatry (2006) 188: 337-345. doi: 10.1192/bjp.188.4.337
© 2006 The Royal College of Psychiatrists
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Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine

Randomised controlled trial

TONY KENDRICK, MD, FRCGP, FRCPsych

Primary Medical Care Group

ROBERT PEVELER, MA, DPhil, FRCPsych

Mental Health Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Southampton

LOUISE LONGWORTH, BA, MSc

Health Economics Research Group, Brunel University, London

DAVID BALDWIN, DM, FRCPsych

Mental Health Group, Clinical Neurosciences Division, University of Southampton School of Medicine

MICHAEL MOORE, BMed Sci, Msc, MRCP, MRCGP

Three Swans Surgery, Salisbury

JUDY CHATWIN, BSc, MSc

Primary Medical Care Group, Community Clinical Sciences Division, University of Southampton School of Medicine

ANDREW THORNETT, MRCGP, FRACGP, FACPsychMed

Faculty of Health and Sciences, Staffordshire University, Stoke on Trent

JONATHAN GODDARD, MSc

Health Care Research Unit, Community Clinical Sciences Division, University of Southampton School of Medicine

MICHAEL CAMPBELL, BSc, MSc, PhD, CStat

School for Health and Related Research, University of Sheffield

HELEN SMITH, MSc, MD, MRCGP, FFPHM

Brighton and Sussex Medical School, Brighton

MARTIN BUXTON, BA

Health Economics Research Group, Brunel University, London

CHRISTOPHER THOMPSON, MD, FRCP, FRCPsych, MRCGP

Mental Health Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Southampton, UK

Correspondence: Professor Tony Kendrick, Primary Medical Care Group, Community Clinical Sciences Division, University of Southampton Medical School, Aldermoor Health Centre, Southampton SO16 5ST, UK.Tel: +44 (0)23 8024 1050; fax: +44 (0)23 8070 1125; e-mail: ark1{at}soton.ac.uk

Declaration of interest T.K., R.P., D.B. and C.T. have received funds from major drug companies which are unrelated to the funding of this study.Funding detailed in Acknowledgements.

Background The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.

Aims To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UKprimary care.

Method An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.

Results No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were £762 (95% CI 553–1059) for TCAs, £875 (95% CI 675–1355) for SSRIs and £867 (95% CI 634–1521) for lofepramine.Cost-effectiveness acceptability curves suggested SSRIs were mostcost-effective (with a probability of up to 0.6).

Conclusions The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.


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