P0048 - A markov process analysis of maintenance treatment with Fluvox-amine in recurrent depression

Abstract

The objective of the study was to determine the cost effectiveness of long-term maintenance treatment with fluvoxamine compared with tricyclic antidepressants (TCAs) in the treatment of patients with depressive disorders.

A Markov process model was used to model mental health status and economic outcomes as they accrued over a hypothetical 5-year follow-up period. The main outcome measures were time without depression, direct and indirect costs. The clinical data were obtained from specially conducted pharmacoepidemiological study of patients with depressive disorders who were prescribed long-term antidepressive treatment in two Moscow outpatient psychiatric clinics; naturalistic study of clinico-social effectiveness of fluvoxamine use for long-term (6 month) maintenance treatment; results of cost-analysis study of depressive disorders; data from published literature.

The results showed the increase of medical expenses in case of fluvoxamine not less than in 1,4 times compared to TCAs and gain of 110 days without disease. In addition it was shown that long-term treatment with fluvoxamine is associated with a mean increase time without depression of 7%. The total costs of maintenance treatment with fluvoxamine (50 mg/day) were substantially lower than with TCAs. When social perspectives were taken into account it was shown that fluvoxamine is recourse-saving and expenses on the cost of the drug are covered by social effect of therapy. Sensitivity analysis confirmed the robustness of these results.

In conclusion, the study demonstrates that long-term maintenance treatment with fluvoxamine is both more effective and less costly (from social perspectives) than treatment with TCAs for patients with depressive disorders.