Cost-effectiveness and cost-utility of selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and tricyclic antidepressants in depression with comorbid cardiovascular disease

ObjectivesEconomic evaluations of interventions for people with mental–physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.DesignA systematic review.Data sourcesMEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.Eligibility criteriaWe included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.Data extraction and synthesisTwo authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.ResultsA total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.ConclusionsEconomic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions.PROSPERO registration numberCRD42022302036.

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“… 46 One study compared three antidepressants. 59 Two studies had two or more comparators, one being the usual care. 55 57 …”

Section: Resultsmentioning

confidence: 99%

Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review

et al. 2023

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“…SSRIs improved quality of life to a greater effect than TCAs in patients with depression, regardless of their CVD status. 64…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Treatment of affective disorders in cardiac disease

Mavrides

Nemeroff

2015

Dialogues in Clinical Neuroscience

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Patients with cardiovascular disease (CVD) commonly have syndromal major depression, and depression has been associated with an increased risk of morbidity and mortality. Prevalence of depression is between 17% and 47% in CVD patients. Pharmacologic and psychotherapeutic interventions have long been studied, and in general are safe and somewhat efficacious in decreasing depressive symptoms in patients with CVD. The impact on cardiac outcomes remains unclear. The evidence from randomized controlled clinical trials indicates that antidepressants, especially selective serotonin uptake inhibitors, are overwhelmingly safe, and likely to be effective in the treatment of depression in patients with CVD. This review describes the prevalence of depression in patients with CVD, the physiological links between depression and CVD, the treatment options for affective disorders, and the clinical trials that demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. Great progress has been made in understanding potential mediators between major depressive disorder and CVD—both health behaviors and shared biological risks such as inflammation.

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“…Findings from cost-effectiveness analysis (CEA) are one of the important aspects of HTA that inform policy decision making. Several CEA studies [3][4][5][6][7][8][9] have been conducted in Asia to inform policy decision making. Most of the CEA studies include standardized methods recommended by the International Society for Pharmacoeconomics and Outcomes Research and Medical Decision Making Modeling Good Practices Task Force [10], such as a base-case analysis and one-way and probabilistic sensitivity analyses.…”

Section: Introductionmentioning

confidence: 99%

Value of Information in Asia: Concepts, Current Use, and Future Directions

Dilokthornsakul

McQueen²,

Chaiyakunapruk

et al. 2016

Value in Health Regional Issues

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Health technology assessment is a form of health policy research that provides policymakers with information relevant to decisions about policy alternatives. Findings from cost-effectiveness analysis (CEA) are one of the important aspects of health technology assessment. Nevertheless, the more advanced method of value of information (VOI), which is recommended by the International Society for Pharmacoeconomics and Outcomes Research and Society for Medical Decision Making Modeling Good Research Practices Task Force, has rarely been applied in CEA studies in Asia. The lack of VOI in Asian CEA studies may be due to limited understanding of VOI methods and what VOI can and cannot help policy decision makers accomplish. This concept article offers audiences a practical primer in understanding the calculation, presentation, and policy implications of VOI. In addition, it provides a rapid survey of health technology assessment guidelines and literature related to VOI in Asia and discusses the future directions of VOI use in Asia and its potential barriers. This article will enable health economists, outcomes researchers, and policymakers in Asia to better understand the importance of VOI analysis and its implications, leading to the appropriate use of VOI in Asia.

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Cost-effectiveness and cost-utility of selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and tricyclic antidepressants in depression with comorbid cardiovascular disease

Cited by 6 publications

References 32 publications

Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review

Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review

Treatment of affective disorders in cardiac disease

Value of Information in Asia: Concepts, Current Use, and Future Directions

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