Economic evaluation of agomelatine relative to other antidepressants for treatment of major depressive disorders in Greece

Abstract

BackgroundMajor depressive disorder (MDD) constitutes an important public health problem, as it is highly prevalent in the industrialized world and it is associated with substantial economic consequences for patients, health care providers, insurance and social security organizations and employers. To conduct an economic evaluation comparing agomelatine with other commonly used alternatives for treating patients with major depressive disorder (MDD) in Greece.MethodsAn existing international Markov model designed to evaluate the cost-effectiveness of agomelatine was adapted to the Greek setting. It reflects six different health states, in which patients may move on a monthly basis. The analysis was undertaken from a societal perspective. Transition probabilities, utilities and costs assigned to each health state were extracted from the published literature, government sources and expert opinion. Data reflects the year 2012 and was discounted using a rate of 3.5%. Probabilistic analysis was undertaken to deal with uncertainty.ResultsBase case analyses revealed that agomelatine is a dominant therapy for MDD relative to escitalopram, fluoxetine and sertraline, and it appeared to be cost-effective compared to venlafaxine (ICER: €547/QALY). Agomelatine remained a dominant treatment against generic sertraline and fluoxetine, and it appeared to be a cost-effective alternative compared to generic venlafaxine and escitalopram (ICER: €1,446/QALY and €3,303/QALY, respectively). Excluding the indirect cost from the analysis, agomelatine remained a cost-effective alternative over all comparators. In the probabilistic sensitivity analysis agomelatine was dominant in 44.5%, 89.6%, 70.6% and 84.6% of simulated samples against branded venlafaxine, escitalopram, fluoxetine and sertraline, respectively.ConclusionThe present evaluation indicates that agomelatine is either a dominant or a cost-effective alternative relative to branded or generic alternatives, in Greece.

Considering the societal perspective in economic evaluations: a systematic review in the case of depression

“…Three studies analysed data from Sweden [ 55 , 56 , 59 ] and another two from India [ 58 , 77 ]. The remaining six studies used data from Japan [ 65 ], Greece [ 53 ], Canada [ 74 ], Belgium [ 26 ], Korea [ 34 ] and Finland [ 70 ].…”

“…Concerning the perspective, 22 of the studies (42%) applied the societal perspective [ 30 , 38 , 40 – 43 , 45 , 48 , 49 , 53 – 57 , 59 , 63 , 66 , 67 , 69 , 71 – 73 , 76 ]. Eighteen studies conducted an evaluation considering both positions [ 26 – 29 , 31 , 32 , 34 , 37 , 39 , 50 , 51 , 58 , 62 , 64 , 65 , 74 , 75 , 77 ] and 12 focused on the healthcare perspective and calculated societal costs separately [ 33 , 35 , 36 , 44 , 46 , 47 , 52 , 60 , 61 , 65 , 70 , 78 ].…”

“…Considering the intervention type, 26% of the studies compared two or more different pharmaceuticals [ 26 , 28 , 34 , 36 , 38 , 53 , 55 – 57 , 59 , 62 , 66 , 69 , 70 ], whereby the main part of the articles evaluated non-pharmaceutical interventions such as cognitive behavioural therapy or other psycho-educational therapies. Collaborative care interventions were evaluated in eight studies [ 27 , 40 , 42 – 44 , 49 , 60 , 72 ] and seven articles focused on a combination of pharmaceutical and psychological interventions [ 46 , 50 , 54 , 58 , 65 , 67 , 75 ].…”

“…The majority (70%) of the 53 economic evaluation studies included CEA as well as CUA. Regarding the study design, most of the publications reported data from randomized controlled trials (RCT) [ 27 – 33 , 35 , 38 – 44 , 46 , 47 , 49 – 52 , 54 , 58 , 60 – 64 , 66 , 67 , 69 , 71 – 73 , 76 – 78 ] and 16 studies used a modelling approach for the calculations [ 26 , 34 , 36 , 37 , 45 , 48 , 53 , 55 – 57 , 59 , 65 , 68 , 70 , 74 , 75 ].…”

Analysis of psychotropic drug-related deaths in south Osaka

“… 11 The burden of depression is significant in terms of direct treatment cost, social and intangible cost, missed working days, lower productivity, and decreased quality of life. 12 In the present study, the medical records of patients who suffered a drug-related death were reviewed.…”