OBJECTIVES: The purpose of this study was to assess the cost-effectiveness of Sertraline vs citalopram for first-line treatment of major depressive disorder (MDD) in Bozorgmehr clinic in Tabriz.

METHODS: A two-path decision analytical model with a 6-month horizon was used. All patients (baseline scores on the Hamilton Depression Rating Scale [HRSD],>9->30) started at primary path, and were referred to specialist care in next path. Model inputs included the following: probabilities from a pragmatic trial performed in Bozorgmehr Clinic in Tabriz, the list of drug prices taken from drug information Pharmacy faculty of Tabriz and costs include indirect and direct costs. Main outcome measures were success (i.e., remission [defined as any decrease in (HAMD)] and costs of treatment (i.e. drug costs and medical care) analyses were performed from the perspectives of the society. Monetary values are reported in year-2015 Rial ($1≈29104IR).

RESULTS: The expected success rate was 37.61 %( 90%CI, 37.61-37.61) for sertraline compared with 50.53 %( 90%CI, 37.61-51.14) for citalopram. From the societal perspective, the expected cost per patient was 101.80(90% CI,13.50-132.93) $ for sertraline compared with 101.4(90% CI ,26.93-142.208)$ for citalopram and incremental cost which provided difference of each drug’s treatment from dominant strategy’s cost was sertraline, and citalopram (0,0.36) as well as incremental effectiveness for sertraline and citalopram was (0, 12.82) respectively so incremental cost-effectiveness provided 0.028 dollars.

CONCLUSIONS: In this analysis, the treatment of MDD with sertraline appeared to be a cost-effective alternative compared with citalopram leading to better clinical outcomes and cost savings compared with citalopram in the model used. The success rate of citalopram is higher but its costs is more and if we want to achieve an additional unit of effectiveness of citalopram comparing to sertraline we should spend 0.028 dollars more.

Keywords: Major Depression Disorder (MDD), Cost-Effectiveness Analysis (CEA), citalopram, sertraline.