CostEffectiveness Analysis of Pharmaceutical Trea

Authors: Lieven Annemans Mélanie Brignone Sylvain Druais Ann De Pauw Aline Gauthier Koen Demyttenaere

Publish Date: 2014/02/20

Volume: 32, Issue: 5, Pages: 479-493

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Abstract

The model structure was based on a decision tree developed by the Swedish TLV Tandvårds och läkemedelsförmånsverket and adapted to the Belgium healthcare setting using primary local data on the patterns of treatment and following KCE Federal Knowledge Center Federaal Kenniscentrum voor de Gezondheidszorg recommendations Comparators were escitalopram citalopram fluoxetine paroxetine sertraline duloxetine venlafaxine and mirtazapine In the model patients not achieving remission or relapsing after remission on the assessed treatment moved to a second therapeutic step titration switch addon or transfer to a specialist In case of failure in the second step or following a suicide attempt patients were assumed to be referred to secondary care The time horizon was 1 year and the analysis was conducted from the National Institute for Health and Disability Insurance NIHDI national health insurance and societal perspectives Remission rates were obtained from the TLV network metaanalysis and risk of relapse efficacy following therapeutic change risk of suicide attempts and related death utilities costs 2012 and resources were derived from the published literature and expert opinion The effect of uncertainty in model parameters was estimated through scenario analyses and a probabilistic sensitivity analysis PSAIn the basecase analysis escitalopram was identified as the optimal strategy it dominated all other treatments except venlafaxine from the NIHDI perspective against which it was cost effective with an incremental costeffectiveness ratio of €6352 per qualityadjusted lifeyear QALY Escitalopram also dominated all other treatments from the societal perspective At a threshold of €30000 per QALY and from the NIHDI perspective the PSA showed that the probability of escitalopram being identified as the optimal strategy ranged from 61  vs venlafaxine to 100  vs fluoxetineEscitalopram was associated with the highest probability of being the optimal treatment from the NIHDI and societal perspectives This analysis based on new Belgian clinical practice data and following KCE requirements provides additional information that may be used to guide the choice of treatments in the management of MDD in Belgium

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