Cost-Effectiveness/Utility Analysis of Two Drug Regimens in the Treatment of Depression

This paper compares the cost-effectiveness/utility of drug regimens based on fluoxetine and moclobemide in the treatment of depression in Finland. The outcome data are based on a 6 week double-blind RCT (n=209) and the cost data on a cost study linked to the RCT (n=141). Quality of life changes were measured by 15D. Five different outcome measures were used. Moclobemide showed consistently a better outcome in all outcome measures, but the differences did not generally reach the conventional limit of statistical significance (5%). The difference in the average time-weighted quality-of-life gain on a 0-1 scale was 0.02 (p=0.08). The direct costs were on average lower in the moclobemide regimen, but the difference was not significant (p=0.14), whereas the average total costs (direct and indirect) were almost the same in both regimens. These results suggest that in terms of incremental cost-effectiveness/utility the moclobemide regimen would dominate (produce a better marginal outcome at a equal or less cost), but this conclusion is surrounded by a slightly higher degree of uncertainty than what is conventionally applied. A larger study is needed to give more precision especially to the cost estimates.