Question

Investigate the cost of treating a patient with tricyclic antidepressants versus SSRIs or with typical antipsychotic medication versus an atypical antipsychotic medication. If you were a nurse case manager, how would you justify use of the more expensive drug to the managed care organization?

Answer 1

• It is generally accepted that the treatment costs for depression are significant, with estimates for the US ranging up to US$43·7 billion. This includes only US$12·4 billion for the costs of treating the patients with depression; the remaining costs are from lost working days, lost income due to suicides, and lost productivity. The high risk of recurrence and chronicity also leads to high direct health care costs. In particular, the frequent and long hospitalizations required for severe depression have an enormous impact in economic terms.
• The other main costs are related to drug and psychotherapy, and the treatment of side?effects, which are particularly pronounced with the tricyclic antidepressants. Preliminary analyses indicate that the differential tolerability of the current selective serotonin reuptake inhibitors (SSRIs) can also give rise to differences in total costs of treatment. Thus, it can be hypothesized that the relatively favourable side?effect profile of the SSRI fluvoxamine may have positive economic consequences, especially as it is one of the lower priced drugs in this class.
• Selective serotonin reuptake inhibitors (SSRIs) as first line treatment for depression were more cost effective than tricyclic antidepressants (TCAs) alone, but less cost effective than TCAs as first line treatment with SSRIs for dropouts.SSRIs have undoubted advantages, and as their price falls they may become first line treatment. For the time being, however, tricyclics remain the most cost effective first line treatment for depression.One of the major advances of the SSRIs antidepressants is their lack of anticholinergic, cardiovascular and other adverse effects, which were a major limitation of the TCAs.