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Are SSRIs a Cost-Effective Alternative to Tricyclics?

Published online by Cambridge University Press:  02 January 2018

Matthew Hotopf ,
Glyn Lewis  and
Charles Normand
Matthew Hotopf*
Affiliation:
Department of Psychological Medicine, King's College School of Medicine and Dentistry, and Institute of Psychiatry
Glyn Lewis
Affiliation:
Epidemiology Unit, London School of Hygiene and Tropical Medicine, and Section of Epidemiology and General Practice, Institute of Psychiatry
Charles Normand
Affiliation:
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
*
Dr Hotopf, Institute of Psychiatry, 103 Denmark Hill, London SE5 8AF
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Abstract

Background

Selective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclics. Reports have suggested that SSRIs are cost-effective because they are better tolerated and safer in overdose.

Method

A systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRIs and tricyclic antidepressants (TCAs).

Results

None of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs drop out of RCTs. Cost-effectiveness studies have been based on crude ‘modelling’ approaches and over-estimate the difference in attrition rates and the cost of treatment failure. It appears impossible to evaluate the economic aspects of suicide because of its rarity.

Conclusions

There is no evidence to suggest that SSRIs are more cost-effective than TCAs. The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 168 , Issue 4 , April 1996 , pp. 404 - 409
Copyright
Copyright © Royal College of Psychiatrists, 1996 

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