C-QUALITY: cost and quality-of-life pharmacoeconomic analysis of antidepressants used in major depressive disorder in the regional Italian settings of Veneto and Sardinia

Claudio Mencacci,¹ Eugenio Aguglia,² Giovanni Biggio,³ Lodovico Cappellari,⁴ Guido Di Sciascio,⁵ Andrea Fagiolini,⁶ Giuseppe Maina,⁷ Alfonso Tortorella,⁸ Pablo Katz,⁹ Claudio Ripellino<sup>9

1</sup>Department of Mental Health, Fatebenefratelli Hospital, Milan, ²Department of Clinical and Molecular Biomedicine, University of Catania, Catania, ³Department of Experimental Biology and Center of Excellence for the Neurobiology of Drug Dependence, University of Cagliari, Calgiari, ⁴Department of Mental Health, Camposampiero Hospital, Padova, ⁵Department of Psychiatry, Policlinico Hospital, Bari, ⁶Department of Molecular Medicine, University of Siena and Department of Mental Health, University of Siena Medical Center, Siena, ⁷Department of Neurosciences, University of Torino, Torino, ⁸Department of Mental Health, University of Naples SUN, Naples, ⁹CSD Medical Research Srl, Milan, Italy

Background: Major depression is a commonly occurring, seriously impairing, and often recurrent mental disorder. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the treatments most commonly used for major depressive disorder. The objective of this study was to assess the cost-effectiveness of SSRIs and SNRIs in the treatment of major depressive disorder in two Italian regional settings, ie, Veneto and Sardinia.
Methods: A decision analytic model was adapted from the Swedish Dental and Pharmaceutical Benefits Agency to reflect current clinical practice in the treatment of major depressive disorder in the most significant Italian regions. This adaptation was possible as a result of collaboration with an expert panel of Italian psychiatrists and health economists. The population comprised patients with a first diagnosis of major depressive disorder and initiating one SSRI or SNRI drug for the first time. The time frame used was 12 months. Efficacy and utility data for the model were retrieved from the literature and validated by the expert panel. Local data were used for resource utilization and for treatment costs based on the perspective of each regional health service. Scenario analyses and probabilistic sensitivity analyses were performed to test the robustness of the model.
Results: Base case analysis showed that escitalopram is associated with the largest health gain (in quality-adjusted life years) and a lower total cost at one year for Sardinia (except for sertraline, against which it was cost-effective) and for Veneto, and therefore dominates the other treatment strategies, given that more quality-adjusted life years are achieved at a lower total cost. Scenario analyses and probabilistic sensitivity analyses support the robustness of the model.
Conclusion: The results indicate that escitalopram is the most cost-effective pharmacologic treatment strategy for both regional health services compared with all SSRIs and all SNRIs used in the first-line treatment of major depressive disorder.

Keywords: antidepressants, major depressive disorder, cost-effectiveness quality of life, Italy