CBT and generic fluoxetine are cost-effective treatment options for both episodic and maintenance treatment of major depression in Thailand. Maintenance treatment has the greatest potential of health gain.
BackgroundPoor adherence to antidepressant therapy is an important barrier to the effective management of major depressive disorder. This study aims to quantify the adherence rate to antidepressant treatment and to determine the pattern of prescriptions of depressed patients in a psychiatric institute in Thailand.MethodsThis retrospective study used electronic pharmacy data of outpatients aged 15 or older, with a new diagnosis of major depression who received at least one prescription of antidepressants between August 2005 and September 2008. The medication possession ratio (MPR) was used to measure adherence over a 6 month period.Results1,058 were eligible for study inclusion. The overall adherence (MPR > 80%) in those attending this facility at least twice was 41% but if we assume that all patients who attended only once were non-adherent, adherence may be as low as 23%. Fluoxetine was the most commonly prescribed drug followed by TCAs. A large proportion of cases received more than one drug during one visit or was switched from one drug to another (39%).ConclusionsAdherence to antidepressant therapy for treatment of major depression in Thailand is rather low compared to results of adherence from elsewhere.
obtained clinical trials data for all drugs represented first line therapy for MDD. For this reason, response rates were down-adjusted to reflect their use as a second-line therapy, with each response rate being multiplied by a factor obtained from the STAR*D-trial. Since response rates were reported at a constant rate in clinical trials, they were converted into "weekly probabilities" of response. Patients entering second-line monotherapy were not differentiated by switch or add-on. QuetiapineXR(150mg) was compared with venlafaxineXR(150mg), escitalopram(10mg) and bupropionXL(300mg), which are considered to be the most relevant monotherapy comparators in Turkey. One-way sensitivity analyses were conducted on key model parameters to evaluate the robustness of the model.
RESULTS:The response rates at any time over 52 weeks were 22.5% for quetiap-ineXR, venlafaxineXR 17.8%, escitalopram 12.6% and bupropionXL 10.7%. In terms of incremental cost per additional second-line responder, quetiapineXR was found to be dominant (more effective and less costly) versus venlafaxineXR (-353.55€) and quetiapineXR was cost-effective (more effective and more costly) versus escitalopram (1785.43€) and bupropionXL (652.90€). The cost per responder of quetiap-ineXR(48.85€) was less than venlafaxineXR(62.68€), escitalopram(73.20€) and bupropionXL(95.52€). CONCLUSIONS: This exploratory analysis demonstrated that in patients with MDD who have failed on previous antidepressant therapy, quetia-pineXR 150mg as monotherapy was found to be cost-effective compared to escitalopram and bupropionXL, in terms of cost per responder, and was dominant when compared to venlafaxineXR, demonstrating higher efficacy at lower costs.
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