Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine: randomised controlled trial.

Background The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRls) has not been compared in a prospective study in primary care. Aims To determine the relative cost effectiveness of TCAs, SSRls and lofepramine in UK primary care. Method An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression. Results No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% Cl 21.3-29.0) for TCAs, 28.3 (95% Cl 24.3-32.2) for SSRls and 24.6 (95% Cl 20.6-28.9) for lofepramine. Mean health service costs per patient were pound762 (95% Cl 553-1059) for TCAs, L875 (95% Cl 675-1355) for SSRls and;pound867 (95% Cl 634-1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRls were most cost-effective (with a probability of up to 0.6). Conclusions The findings support a policy of recommending SSRIs as firstchoice antidepressants in primary care. Declaration of interest T.K., R.P., D.B. and CT have received funds from major drug companies which are unrelated to the funding of this study Funding detailed in Acknowledgements.