Healthcare expenditure in severely depressed patients treated with escitalopram, generic SSRIs or venlafaxine in the UK

Abstract

Objective:

To retrospectively compare the 12-month healthcare utilisation and direct medical costs associated with the use of escitalopram, generic SSRIs, and venlafaxine in patients with severe depression in the United Kingdom (UK).

Methods:

Data for this retrospective cohort study were extracted from the GPRD, a large primary care database in the UK. Data from adults with an incident prescription of escitalopram, venlafaxine, or generic SSRI were extracted. The initial prescription had to fall within 3 months of a physician visit when severe depression according to the GPRD definition was mentioned. Frequency of antidepressant treatment, GP consultations, referrals, hospitalisations, and concomitant psychiatric medication was assessed on the 12-months after initial prescription and 2006 unit costs for healthcare services obtained from published literature were applied, and then compared between treatment cohorts using a propensity score-adjusted generalised linear model.

Results:

The total annual healthcare expenditure per patient was similar with escitalopram and generic SSRIs (£916 vs. £974, adjusted p = 0.48) and significantly lower than venlafaxine (£916 vs. £1367, adjusted p < 0.0001), a pattern repeated when antidepressant costs were excluded from the analysis (escitalopram vs. SSRIs, £831 vs. £957, adjusted p = 0.10; escitalopram vs. venlafaxine, £831 vs. £1156, adjusted p = 0.006). Over the 12-month analysis period, there were significantly fewer hospitalisations per patient in the escitalopram vs. venlafaxine (0.12 vs. 0.27; adjusted p = 0.01) or generic SSRI (0.12 vs. 0.19; adjusted p = 0.046) groups.

Conclusion:

Despite some limitations associated with the system of data collection in the GPRD (need to apply proxies for severity assessment and external unit costs to resource consumption), the results of this real-life study brings additional evidence of escitalopram appearing to be a cost-effective treatment for patients suffering from severe depression as diagnosed in routine practice and could be considered for first-line treatment in these patients.

Key words::

• Antidepressive agents
• Escitalopram
• GPRD
• Healthcare costs
• Retrospective studies
• Selective serotonin reuptake inhibitors
• Severe depression
• Venlafaxine

Transparency

Declaration of funding

This study was funded by H. Lundbeck A/S, manufacturer of escitalopram.

Declaration of financial/other relationships

D.S., N.D. and C.F. have disclosed that they are full-time employees of Lundbeck. A.G.W. has disclosed that he is a consultant to Lundbeck and received consultancy fees, lecture fees and research grants from the company. F.G. has disclosed that he is consultant to Lundbeck and received consultancy fees from the company. M.T. has disclosed that he has consulted for Lundbeck and provided epidemiological consultancy for the company.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgements

Natalie Barker of Wolters Kluwer Health provided writing assistance for this manuscript, funded by Lundbeck.

Data presented in this paper were previously presented at the 24th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Copenhagen, Denmark, August 17–20, 2008; at the 21st European College of Neuropsychopharmacology Congress, 30 August – 3 September 2008, Barcelona, Spain; and at the 11th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research, 8–11 November 2008, Athens, Greece.