Cost-effectiveness analysis of pharmaceutical treatment options in the first-line management of major depressive disorder in Belgium

The objective of this study was to assess the cost effectiveness of commonly used antidepressants as first-line treatment of major depressive disorder (MDD) in Belgium. The model structure was based on a decision tree developed by the Swedish TLV (TandvAyenrds- och lakemedelsformAyennsverket) and adapted to the Belgium healthcare setting, using primary local data on the patterns of treatment and following KCE [Federal Knowledge Center (Federaal Kenniscentrum voor de Gezondheidszorg)] recommendations. Comparators were escitalopram, citalopram, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine, and mirtazapine. In the model, patients not achieving remission or relapsing after remission on the assessed treatment moved to a second therapeutic step (titration, switch, add-on, or transfer to a specialist). In case of failure in the second step or following a suicide attempt, patients were assumed to be referred to secondary care. The time horizon was 1 year and the analysis was conducted from the National Institute for Health and Disability Insurance (NIHDI; national health insurance) and societal perspectives. Remission rates were obtained from the TLV network meta-analysis and risk of relapse, efficacy following therapeutic change, risk of suicide attempts and related death, utilities, costs (2012), and resources were derived from the published literature and expert opinion. The effect of uncertainty in model parameters was estimated through scenario analyses and a probabilistic sensitivity analysis (PSA). In the base-case analysis, escitalopram was identified as the optimal strategy: it dominated all other treatments except venlafaxine from the NIHDI perspective, against which it was cost effective with an incremental cost-effectiveness ratio of a,not sign6,352 per quality-adjusted life-year (QALY). Escitalopram also dominated all other treatments from the societal perspective. At a threshold of a,not sign30,000 per QALY and from the NIHDI perspective, the PSA showed that the probability of escitalopram being identified as the optimal strategy ranged from 61 % (vs. venlafaxine) to 100 % (vs. fluoxetine). Escitalopram was associated with the highest probability of being the optimal treatment from the NIHDI and societal perspectives. This analysis, based on new Belgian clinical practice data and following KCE requirements, provides additional information that may be used to guide the choice of treatments in the management of MDD in Belgium

Characteristics of patients with depression initiating or switching antidepressant treatment: baseline analyses of the PERFORM cohort study

BACKGROUND: Patients who require a switch in their antidepressant therapy may have different clinical profiles and treatment needs compared with patients initiating or maintaining a first-line antidepressant therapy. METHODS: The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (MDD) (PERFORM) study was a 2-year observational cohort study in outpatients with MDD in five European countries. Enrolled patients were either initiating or undergoing the first switch to an antidepressant monotherapy. Baseline data on patients' clinical status, functioning, productivity, quality of life and medical-resource use were compared in a cross-sectional baseline analysis. RESULTS: A total of 1402 patients were enrolled, of whom 1159 (82.7%) provided analysable baseline data. The majority (78.7%) of the analysable population were initiating antidepressant treatment and most (83.6%) were enrolled and followed up by general practitioners. Compared with patients initiating antidepressants, those switching antidepressants (21.3%) tended to have more severe depressive symptoms, greater anxiety, worse health-related quality of life, greater functional impairment, greater medical-resource use and had a different medical history. Limitations included an over-representation of switches due to lack of efficacy among patients who were switching treatment, as patients were selected based on presence of depressive symptoms. CONCLUSIONS: Patients with MDD who are switching treatment for the first time have a different profile and different depression-associated health needs compared with those initiating treatment. Therapeutic management should therefore be adapted for patients who switch. TRIAL REGISTRATION: ClinicalTrials.gov NCT01427439 ; Retrospectively registered 26 August 2011

Les méta-analyses d'essais randomisés méritent-elles leur statut de plus haut niveau de preuve ? (exemple du cancer bronchique)

PARIS-BIUP (751062107) / SudocSudocFranceF

Efficacy and tolerability of switching therapy to vortioxetine versus other antidepressants in patients with major depressive disorder

<div>Abstract<p><b>Objectives:</b></p><p>To assess the relative efficacy and tolerability of vortioxetine against different antidepressant monotherapies in patients with major depressive disorder (MDD) with inadequate response to selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI) therapy.</p><p><b>Methods:</b></p><p>A systematic search was conducted for monotherapy studies in patients with MDD with inadequate response to first-line therapy. Treatments included SSRIs, SNRIs, and other antidepressants. Identified studies underwent a three-stage screening/data extraction process and critical appraisal. Adjusted indirect treatment comparisons (ITCs) on systematic literature review outputs were made using Bucher’s method, comparing remission rates and withdrawal rates due to adverse events (AEs).</p><p><b>Results:</b></p><p>Of 27 studies meeting the inclusion criteria, a few studies were of high quality according to the National Institute of Health and Care Excellence checklist. Three studies contributed to an evidence network for quantitative assessment comparing vortioxetine with agomelatine, sertraline, venlafaxine XR, and bupropion SR. Vortioxetine had a statistically significantly higher remission rate than agomelatine (risk difference [RD]: −11.0% [95% CI: −19.4; −2.6]), and numerically higher remission rates than sertraline (RD: −14.4% [95% CI: −29.9; 1.1]), venlafaxine (RD: −7.20% [95% CI: −24.3; 9.9]), and bupropion (RD: −10.70% [95% CI: −27.8; 6.4]). Withdrawal rates due to AEs were statistically significantly lower for vortioxetine than sertraline (RD: 12.1% [95% CI: 3.1; 21.1]), venlafaxine XR (RD: 12.3% [95% CI: 0.8; 23.8]), and bupropion SR (RD: 18.3% [95% CI: 6.4; 30.1]).</p><p><b>Conclusions:</b></p><p>The current systematic literature review found a few high quality switch studies assessing monotherapies in patients with MDD with inadequate response to SSRI/SNRIs. ITCs indicated that switching to vortioxetine leads to numerically higher remission rates compared with other antidepressants. Vortioxetine is a well tolerated treatment, showing statistically lower withdrawal rates due to AEs compared with other antidepressants. Vortioxetine is a relevant therapeutic alternative in patients experiencing inadequate response to prior SSRI or SNRI therapy.</p></div

Perception of alopecia by patients requiring chemotherapy for non-small-cell lung cancer: A willingness to pay study

Objective: Chemotherapy-induced alopecia may have a substantial impact on the quality of life (QOL) of lung cancer patients, but very few data are available. The aim of this study was to assess the perceived impact of alopecia based on a " willingness to pay" (WTP) approach. Methods: We conducted a prospective multicenter WTP study of patients receiving chemotherapy for non-small-cell lung cancer (NSCLC). The perceived impact of alopecia was assessed with a visual analogue scale (VAS; 0: no impact, 10: major impact), and from the patients' willingness to pay for chemotherapy that had the same efficacy, dosing schedule and tolerability as the standard treatment but that cut the risk of alopecia from 40% to 5%. Results: Among the 135 patients enrolled in this study, the mean score on the VAS for the perceived likely impact of alopecia was 4.4 ± 0.3. The mean WTP for a 3-week chemotherapy cycle reducing the risk of alopecia from 40% to 5% was €83.4 ± 10.2 (€median 37.5), representing 2.1% of total income, while 27% of patients were unwilling to pay anything. There was a significant association between WTP and gender (women, p&lt; 0.01), annual incomes (p&lt;0.01), but not with marital status, level of education or occupations. Conclusion: Alopecia appears to be an important outcome for patients receiving chemotherapy for NSCLC. Women and patients with high annual incomes were more willing to pay. © 2010 Elsevier Ireland Ltd

Relative efficacy and tolerability of vortioxetine versus selected antidepressants by indirect comparisons of similar clinical studies

International audienc

Prise en charge et suivi des patients traités par prophylaxie antirétrovirale : évaluation des pratiques personnelles

International audienc

Characteristics of patients with depression initiating or switching antidepressant treatment: baseline analyses of the PERFORM cohort study

BACKGROUND: Patients who require a switch in their antidepressant therapy may have different clinical profiles and treatment needs compared with patients initiating or maintaining a first-line antidepressant therapy. METHODS: The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (MDD) (PERFORM) study was a 2-year observational cohort study in outpatients with MDD in five European countries. Enrolled patients were either initiating or undergoing the first switch to an antidepressant monotherapy. Baseline data on patients' clinical status, functioning, productivity, quality of life and medical-resource use were compared in a cross-sectional baseline analysis. RESULTS: A total of 1402 patients were enrolled, of whom 1159 (82.7%) provided analysable baseline data. The majority (78.7%) of the analysable population were initiating antidepressant treatment and most (83.6%) were enrolled and followed up by general practitioners. Compared with patients initiating antidepressants, those switching antidepressants (21.3%) tended to have more severe depressive symptoms, greater anxiety, worse health-related quality of life, greater functional impairment, greater medical-resource use and had a different medical history. Limitations included an over-representation of switches due to lack of efficacy among patients who were switching treatment, as patients were selected based on presence of depressive symptoms. CONCLUSIONS: Patients with MDD who are switching treatment for the first time have a different profile and different depression-associated health needs compared with those initiating treatment. Therapeutic management should therefore be adapted for patients who switch. TRIAL REGISTRATION: ClinicalTrials.gov NCT01427439 ; Retrospectively registered 26 August 2011

Cost-effectiveness of vortioxetine <i>versus</i> venlafaxine (extended release) in the treatment of major depressive disorder in South Korea

<div><p>ABSTRACT</p><p><b><i>Objective</i></b>: To assess the cost-effectiveness of vortioxetine <i>versus</i> venlafaxine XR (extended-release) in major depressive disorder (MDD) patients in South Korea.</p><p><b><i>Methods</i></b>: A 1-year cost-effectiveness analysis from a limited societal perspective was performed using a combined model consisting of a decision-tree and a Markov model. Patients entered the model when initiating or switching antidepressant treatment following inadequate response to previous treatment. Remission, relapse and recovery were the main health states.</p><p><b><i>Results</i></b>: Vortioxetine dominated venlafaxine XR, with quality-adjusted life year (QALY) gains of 0.0131 and cost savings of KRW 623,229/year [US$530/year] from a limited societal perspective. Safety contributed more than efficacy to the incremental QALY gains. More patients were in recovery after initial treatment and after 1 year with vortioxetine (31%, 40%) compared to venlafaxine XR (23%, 36%). Vortioxetine remained dominant in 98% of probabilistic simulations.</p><p><b><i>Conclusion</i></b>: Vortioxetine dominated venlafaxine XR in South Korea and is a relevant treatment option for MDD patients initiating or switching therapy.</p></div