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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

Long-term projections of the cost-effectiveness of 2-year prophylactic treatment, with varying risk reductions of future recurrences. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year
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fig03: Long-term projections of the cost-effectiveness of 2-year prophylactic treatment, with varying risk reductions of future recurrences. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year

Mentions: In our base-case analysis, we aligned the design of the model closely to that of the clinical trial. This did, however, not allow for multiple recurrences and recovery and thus an extended Markov model was developed. The extended model resulted in ICERs varying from $69,500 with a 6-month time frame to $32,400 with a two-treatment period and time frame for the analysis. Based on the extended model long-term projections were conducted of the cost-effectiveness of prophylactic treatment. Extending the time frame of the analysis to 3 and 4 years, resulted in further decrease of the ICER (Table 5). Longer-time horizons of the analysis resulted in cost-effectiveness ratios of around $17,600 (Figure 3). Assuming that prophylactic treatment reduces the long-term risk of recurrences improves the ICER even further.


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)

Long-term projections of the cost-effectiveness of 2-year prophylactic treatment, with varying risk reductions of future recurrences. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year
© Copyright Policy
Related In: Results  -  Collection

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

fig03: Long-term projections of the cost-effectiveness of 2-year prophylactic treatment, with varying risk reductions of future recurrences. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year
Mentions: In our base-case analysis, we aligned the design of the model closely to that of the clinical trial. This did, however, not allow for multiple recurrences and recovery and thus an extended Markov model was developed. The extended model resulted in ICERs varying from $69,500 with a 6-month time frame to $32,400 with a two-treatment period and time frame for the analysis. Based on the extended model long-term projections were conducted of the cost-effectiveness of prophylactic treatment. Extending the time frame of the analysis to 3 and 4 years, resulted in further decrease of the ICER (Table 5). Longer-time horizons of the analysis resulted in cost-effectiveness ratios of around $17,600 (Figure 3). Assuming that prophylactic treatment reduces the long-term risk of recurrences improves the ICER even further.

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