COST-EFFECTIVENESS ANALYSIS OF AGOMELATINE VERSUS SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN TREATMENT OF PATIENTS WITH MAJOR DEPRESSION IN IRAN
Author(s)
Varmaghani M1, Heidari E2, Mansouri M3, Habibi-Moini M4, Nilforoushzadeh M4, Karkhaneh-Yousefi M4, Taheri S5, Seyyedifar M6
1Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, Mashhad, Iran (Islamic Republic of), 2Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran (Islamic Republic of), 3Students’ Health Services, Students’ Health and Consultation Center, Tarbiat Modares University, Tehran, Iran, Tehran, Iran (Islamic Republic of), 4Tadbir Kala Jam Pharmaceutical Company, Tehran, Iran (Islamic Republic of), 5Department of Pharmacoeconomics and Pharma Management, Shahid Beheshti University of Medical Sciences, School of Pharmacy, Tehran, Iran, 6Tehran University of Medical sciences, Tehran, 07, Iran
OBJECTIVES: Agomelatine, an atypical antidepressant is used in patients with major depression, who have inadequate responses or intolerable side effects during first-line treatment with selective serotonin reuptake inhibitors (SSRIs). The study aimed to evaluate the cost-effectiveness of Agomelatine versus five SSRIs in treatment of major depression from payer perspective in Iran. METHODS: A systematic review was conducted to evaluate efficacy (Quality-adjusted life year) of Agomelatine in comparison with other alternatives. The comparison arms included Fluoxetine, Fluvoxamine, Sertraline, Trazodone, and Duloxetine. Based on the findings of the systematic review, the economic analysis was developed. Model inputs were defined daily dose (DDD), drug acquisition cost (from the recent price list published by Iranian ministry of health), and efficacy (QALYs) for each antidepressant. All costs were in USD and the discount rate for cost and QALYs was considered 5% and 3%, respectively. Outcomes measured included incremental cost effectiveness ratios (ICERs) calculated as Incremental cost (USD) and incremental effectiveness. One-way sensitivity analysis was conducted to test model robustness using the confidence interval of cost and effectiveness. RESULTS: Total cost per DDD over a one year period of study was 72 USD for Agomelatine, 4 USD for Fluoxetine, 33 USD for Fluvoxamine, 23 USD for Sertraline, 29 USD for Trazodone, and 78 USD for Duloxetine. QALY gained was 0.2671 for Agomelatine compared to 0.2601 for Fluoxetine, 0.2629 for Fluvoxamine, 0.2602 for Sertraline, 0.2618 for Trazodone, and 0.2633 for Duloxetine. Among the compared antidepressants, Agomelatine was more effective and less costly than Duloxetine and thus, dominated Duloxetine. Also, in comparison with other alternatives, Agomelatine was less costly than the standard threshold which means Agomelatine was comparatively cost effective. The sensitivity analysis indicated that results varied with potential changes in drug costs. CONCLUSIONS: The study suggested that Agomelatine was dominant compared to Duloxetine in the treatment of depression.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PMH38
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Mental Health
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