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The cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder.

Sobocki P, Ekman M, Ovanfors A, Khandker R, Jönsson B - Int. J. Clin. Pract. (2008)

Bottom Line: In the base-case analysis, the cost per QALY gained of venlafaxine compared with no treatment was estimated at $18,500 over 2 years.In a probabilistic sensitivity analysis, we found that maintenance treatment with venlafaxine is cost-effective with 90% probability at a willingness to pay per QALY of $67,000 or less.Our long-term analyses also indicate that even under conservative assumptions about future risks of recurrences, maintenance treatment is cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Aims: The Prevention of Recurrent Episodes of Depression with venlafaxine XR for Two Years trial has reported advantages with maintenance treatment for patients with recurrent depressive disorder. The aim of this study was to assess the cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder, based on a recent clinical trial.

Methods: A Markov simulation model was constructed to assess the cost-utility of maintenance treatment for 2 years in recurrently depressed patients in Sweden. Risk of relapse and recurrence was based on a recent randomised clinical trial assessing the efficacy and tolerability of maintenance treatment with venlafaxine over 2 years. Costs and quality of life estimations were retrieved from a naturalistic longitudinal observational study conducted in Sweden. Health effects were quantified as quality-adjusted life-years (QALYs). Sensitivity analyses were conducted on key parameters employed in the model.

Results: In the base-case analysis, the cost per QALY gained of venlafaxine compared with no treatment was estimated at $18,500 over 2 years. In a probabilistic sensitivity analysis, we found that maintenance treatment with venlafaxine is cost-effective with 90% probability at a willingness to pay per QALY of $67,000 or less. Our long-term analyses also indicate that even under conservative assumptions about future risks of recurrences, maintenance treatment is cost-effective.

Conclusion: The present study indicates that maintenance treatment for 2 years with venlafaxine is cost-effective in patients with recurrent major depressive disorder.

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Related in: MedlinePlus

Structure of the Markov cohort simulation model
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fig01: Structure of the Markov cohort simulation model

Mentions: Cost-effectiveness analysis in depression generally requires modelling, as all the required data are seldom available from a single dataset over the relevant timeframe. For the present analysis, a Markov model was developed in line with the design of the Prevention of Recurrent Episodes of Depression with VENlafaxine XR for Two Years study (4), and is a modified version of a previously published model (13). The structure of the model is shown in the state transition diagram in Figure 1. In a Markov model, the patients are classified into a number of different health states, each associated with a certain cost and utility. As time progresses in the model, the patients can move between different states (depressive episode, remission, well and dead) according to a set of transition probabilities. Patients may move from one health state to another during a defined interval of time called a cycle.


The cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder.

Sobocki P, Ekman M, Ovanfors A, Khandker R, Jönsson B - Int. J. Clin. Pract. (2008)

Structure of the Markov cohort simulation model
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2327222&req=5

fig01: Structure of the Markov cohort simulation model
Mentions: Cost-effectiveness analysis in depression generally requires modelling, as all the required data are seldom available from a single dataset over the relevant timeframe. For the present analysis, a Markov model was developed in line with the design of the Prevention of Recurrent Episodes of Depression with VENlafaxine XR for Two Years study (4), and is a modified version of a previously published model (13). The structure of the model is shown in the state transition diagram in Figure 1. In a Markov model, the patients are classified into a number of different health states, each associated with a certain cost and utility. As time progresses in the model, the patients can move between different states (depressive episode, remission, well and dead) according to a set of transition probabilities. Patients may move from one health state to another during a defined interval of time called a cycle.

Bottom Line: In the base-case analysis, the cost per QALY gained of venlafaxine compared with no treatment was estimated at $18,500 over 2 years.In a probabilistic sensitivity analysis, we found that maintenance treatment with venlafaxine is cost-effective with 90% probability at a willingness to pay per QALY of $67,000 or less.Our long-term analyses also indicate that even under conservative assumptions about future risks of recurrences, maintenance treatment is cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.

ABSTRACT

Aims: The Prevention of Recurrent Episodes of Depression with venlafaxine XR for Two Years trial has reported advantages with maintenance treatment for patients with recurrent depressive disorder. The aim of this study was to assess the cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder, based on a recent clinical trial.

Methods: A Markov simulation model was constructed to assess the cost-utility of maintenance treatment for 2 years in recurrently depressed patients in Sweden. Risk of relapse and recurrence was based on a recent randomised clinical trial assessing the efficacy and tolerability of maintenance treatment with venlafaxine over 2 years. Costs and quality of life estimations were retrieved from a naturalistic longitudinal observational study conducted in Sweden. Health effects were quantified as quality-adjusted life-years (QALYs). Sensitivity analyses were conducted on key parameters employed in the model.

Results: In the base-case analysis, the cost per QALY gained of venlafaxine compared with no treatment was estimated at $18,500 over 2 years. In a probabilistic sensitivity analysis, we found that maintenance treatment with venlafaxine is cost-effective with 90% probability at a willingness to pay per QALY of $67,000 or less. Our long-term analyses also indicate that even under conservative assumptions about future risks of recurrences, maintenance treatment is cost-effective.

Conclusion: The present study indicates that maintenance treatment for 2 years with venlafaxine is cost-effective in patients with recurrent major depressive disorder.

Show MeSH
Related in: MedlinePlus