Cost-effectiveness of vortioxetine compared with levomilnacipran and vilazodone in patients with major depressive disorder switching from an initial antidepressant

ABSTRACT

Introduction: Many patients with major depressive disorder (MDD) do not achieve remission with their first antidepressant (AD), resulting in a high burden due to treatment failure. Vortioxetine is a valid treatment option for patients with MDD only partially responding to their first AD. Characterization of vortioxetine’s potential benefits versus other approved treatments is important.

Areas covered: The cost-effectiveness of vortioxetine, including cognitive outcomes, was modeled in comparison with levomilnacipran and vilazodone for patients switched to these medications after inadequate responses to a first AD.

Expert opinion: Vortioxetine was associated with incremental quality-adjusted life-year (QALY) gains versus levomilnacipran (0.008) or vilazodone (0.009). Vortioxetine was dominant versus levomilnacipran and cost-effective versus vilazodone (incremental cost-effectiveness ratio [ICER],33,829 USD/QALY). In sensitivity analyses using residual cognitive dysfunction rates (vortioxetine, 49%; levomilnacipran, 58%, and vilazodone, 64%), incremental QALY gains for vortioxetine versus levomilnacipran (0.0085) or vilazodone (0.0109) were found. Vortioxetine remained dominant versus levomilnacipran and cost-effective versus vilazodone (ICER, 27,633 USD/QALY). ICER reduction was found with cognition outcomes inclusion. This model provides additional support for considering vortioxetine for patients requiring a switch of MDD treatments, although its conclusions are limited by the data available for inclusion. Additional research and real-world trials are needed to confirm the findings.

KEYWORDS:

• Antidepressants
• incremental cost-effectiveness
• levomilnacipran
• major depressive disorder
• quality-adjusted life-year
• vilazodone
• vortioxetine

Article Highlights

• Many patients with major depressive disorder do not achieve remission with their first antidepressant medication, and no available antidepressants are formally recognized as the optimal choice for follow-on treatment.

• Vortioxetine is a multimodal antidepressant with proven efficacy and tolerability; however, its cost-effectiveness has not been evaluated against the other contemporary branded antidepressants. (i.e., levomilnacipran and vilazodone) in the United States.

• A modified cost-utility model that included an evaluation of cognition simulated the management of patients requiring second-line treatment after an inadequate response to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor.

• The model showed that vortioxetine was the most effective antidepressant based on quality-adjusted life-year (QALY) analyses (additional QALY, 0.009 vs vilazodone and 0.008 vs levomilnacipran) and was dominant versus levomilnacipran and cost-effective versus vilazodone based on the incremental cost-effectiveness ratio (33,829 USD/QALY).

• Residual cognition rates of 49% for vortioxetine, 58% for levomilnacipran, and 64% for vilazodone were used in the cognitive scenario analysis.

• Patients who received vortioxetine displayed better efficacy in terms of remission and recovery rates and better tolerability, with lower short- and long-term adverse event rates compared with patients who received levomilnacipran or vilazodone.

• Limitations of these analyses include those relating to the reliance on indirect comparison data, inexact estimations of real-world costs, and variability with respect to the reliability of the assumptions applied to the model.

Declaration of Interests

Kokuvi Atsou, Mélanie Brignone, Natalya Danchenko, and Françoise Diamand were employees of Lundbeck at the time of model development. Larry Ereshefsky was a consultant to Lundbeck. Lisa Mucha was an employee of Takeda at the time of model development. Maëlys Touya is an employee of Lundbeck. Russell Becker is a paid consultant to Lundbeck on the economic model. Clément François was an employee of Lundbeck at the time of model development and owned Lundbeck stock. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Acknowledgments

The authors thank Benjamin Briquet, MSc, for his input and contributions to this manuscript. Medical writing and editorial assistance in the preparation of this article was provided by ICON (North Wales, PA, USA), which was supported by Lundbeck.

Information Resources

In addition to the highlighted references, there are websites that provide useful information about depression, including treatment pathways. Examples include an interactive website from the National Institute for Health and Care Excellence (NICE [https://pathways.nice.org.uk/pathways/depression#path=view%3A/pathways/depression/depression-overview.xml&content=view-index]) and a website from the College of Psychiatric & Neurologic Pharmacists (https://cpnp.org/guideline/external/depression) that has links to a number of treatment guidelines for depression.

Additional information

Funding

Financial support for research conduct and manuscript preparation was provided by Lundbeck.