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Comment
. 2023 Sep-Oct;55(5):293-298.
doi: 10.4103/ijp.ijp_854_22.

Cost-minimization analysis of escitalopram, fluoxetine, and amitriptyline in the treatment of depression

Harshit Hemant Salian  1 , M V Raghav  2 , Vikram Singh Rawat  3 , A Divakar  4
Affiliations
Comment

Cost-minimization analysis of escitalopram, fluoxetine, and amitriptyline in the treatment of depression

Harshit Hemant Salian et al. Indian J Pharmacol. 2023 Sep-Oct.

Abstract

Introduction: Escitalopram, fluoxetine, and amitriptyline are the drugs commonly used in the treatment of depression. The pharmacoeconomic evaluation of these drugs becomes relevant as they are prescribed for a long period of time, and depression causes a significant economic burden. The cost-minimization study would contribute to bringing down the annual treatment costs, leading to better medication adherence and ultimately better patient outcomes.

Materials and methods: All drug prices are mentioned in Indian National Rupee (INR). All expenses are based on 2022 pricing. No cost discounting was used because all expenditures were calculated over a year. We considered hypothetical scenarios where the patient was prescribed the lowest possible dose for depression, an equivalent antidepressant dose, a defined daily dose, and the maximum acceptable therapeutic dose for depression.

Results: Annual average treatment costs of amitriptyline, escitalopram, and fluoxetine in patients with depression at baseline with equivalent dosing as mono-drug therapy were 2765.53, 2914.78, and 1422.72 rupees (INR), respectively. Savings were high when the patient was shifted to fluoxetine from either escitalopram or amitriptyline. The savings from switching to fluoxetine were 50.66% and 56.42% from escitalopram and amitriptyline, respectively.

Conclusion: The choice of an antidepressant depends on multiple aspects, among which the cost of treatment plays a crucial role. Among the drugs compared, fluoxetine seems to offer greater value for money. The study emphasizes that selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants not only because of their favorable pharmacological profile but also because of their affordability.

Keywords: Depression; National List of Essential Medicines; National Pharmaceutical Pricing Authority; pharmacoeconomic study.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
The annual treatment cost, percentage cost difference, and percentage savings in the annual cost of escitalopram and amitriptyline in patients with depression
Figure 2
Figure 2
The annual treatment cost, percentage cost difference, and percentage savings in the annual cost of amitriptyline and fluoxetine in patients with depression
Figure 3
Figure 3
The annual treatment cost, percentage cost difference, and percentage savings in the annual cost of escitalopram and fluoxetine in patients with depression
See this image and copyright information in PMC

Comment on

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