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| |  HMO Depression Study Finds Fluoxetine More Cost-efficient Than Other SSRIs PULLMAN, Wa. -- December 12, 1995 -- A study published today in the November/December issue of the Journal of International Medical Research finds that fluoxetine, a selective serotonin re-uptake inhibitor (SSRI), is significantly more cost-efficient than other medications used in the treatment of clinical depression. The study compared direct health-service expenditures for treating depression among 744 patients enrolled in a health maintenance organization. The patients were prescribed one of three SSRIs--fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft). Directing the research was Dr. David A. Sclar, B.Pharm., Ph.D., associate professor of health policy and administration and Boehringer Ingelheim Scholar in Pharmaceutical Economics at Washington State University. Sclar also serves as director of the Center for Health Services Research & Policy for the Inland Northwest Division of Qual-Med Health Plan of Washington, Inc. Evaluating patient-level paid claims data from January 1, 1989 to March 31, 1994, the researchers determined that the annual mean costs for health care services for patients receiving fluoxetine was $442, compared to a mean cost of $744 for paroxetine patients and $756 for sertraline patients. The conditions of the study required that subjects be ambulatory patients between the ages of 18 and 65 who had a confirmed diagnosis of depression (ICD-9-CM or DSM-IV Code 296.2). There were 348 patients prescribed fluoxetine, 128 prescribed paroxetine, and 268 prescribed setraline. The study was guided by two primary research questions, Sclar wrote in the journal article: "Does a requirement of dosage titration with SSRIs correlate with an increase in health service expenditures for the treatment of depression?" "Do comparable safety and efficacy results stemming from randomized clinical trials involving SSRIs equate to comparable economic outcomes in everyday clinical use of the medications?" To answer these questions the researchers utilized the computer archive of a network-model HMO serving 700,000 beneficiaries. They employed multivariate regression analysis to compile their findings. Using this statistical technique, they determined that treatment with paroxetine was associated with a $284.64 per capita increase in health service utilization when compared to fluoxetine. Treatment with setraline was associated with a $315.96 increase over fluoxetine. Sclar said the results showed that when dosage titration (changing the strength of a prescription based on a patient's response to the medication) was required with an SSRI, there was a 52 percent increase in per capita health service expenditures among patients diagnosed by primary care physicians, and a 46 percent increase among patients diagnosed by psychiatrists. Patients prescribed paroxetine or sertraline were found to require dosage titration in 28.1 percent and 40.3 percent of patients respectively, compared with a 16.1 percent for fluoxetine. "The treatment, morbidity, and mortality associated with depression in this country is estimated to consume $44 billion annually," Sclar said. "Yet, to date there exists little comparative data regarding the economic outcomes associated with the use of SSRIs." "At the managerial and practice levels, our findings argue persuasively for the use of antidepressant pharmacotherapy requiring minimal, if any, dosage titration," he said. Sclar said the research indicated that clinical trials, which are used to determine the safety and efficacy of medications, may not be optimal for determining economic outcomes. Previous research conducted by Sclar compared fluoxetine to three tricyclic antidepressants (amitriptyline, desipramine, and nortriptyline) and found fluoxetine more cost-efficient. Funding for the study published in the Journal of International Medical Research was provided by the Center for Health Services Research & Policy, Qual-Med Health Plan of Washington, Inc., Inland Northwest Division, and Eli Lilly and Company. CONTACT: Washington State University | Office of News and Information Services | Al Ruddy 509-335-3581 | ruddy@wsu.edu | or | Richard Chamberlain 212-732-6111
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