Psychiatria pre prax 3/2005

COMPARISON OF THE COST OF TREATMENT OF MAJOR DEPRESSIVE EPIZODE WITH ESCITALOPRAM AND A GENERIC CITALOPRAM BY MEANS OF A PHARMACOECONOMIC MODEL

A pharmacoeconomic model was used for comparing direct costs of 6-month treatment of major depressive episode with either racemic citalopram (R- and S-citalopram), or its pharmacologically active enantiomer, S-citalopram (escitalopram). The purpose of the study was to find whether the superior efficacy of escitalopram would lead to lower consumption and cost of medical care and compensate this way for slightly lower price of citalopram. The probability model of possible trajectories of patient’s path through different types of psychiatric care, depending of patient’s response to treatment, showed that in spite of currently higher price of escitalopram (CZK 15.- for DDD) in comparison to citalopram (CZK 13.- for DDD), the estimated costs of a 6-month treatment course by a psychiatrist were CZK 7 665,- in case the treatment commenced with escitalopram and CZK 8 248.- in case the treatment commenced with citalopram, i.e. CZK 583.- in favour of escitalopram. A parallel model showed, that further savings would be possible by allowing prescription of escitalopram by GP, with switching to specialized psychiatrist psychiatric care only in case the original therapy should fail. For such arrangement, the model showed the biggest cost difference between the treatment of major depressive episode with escitalopram commenced by GP and the treatment with citalopram by psychiatrist, amounting CZK 2 244.- for a 6-month treatment of an average patient suffering from major depressive episode.

Keywords: pharmacoeconomics, escitalopram, major depressive disorder.