Objective: To estimate cost per patient achieving treatment adequacy with venlafaxine extended-release (VENXR) or fluoxetine.
Design: Retrospective cost-effectiveness analysis was performed using a US payer’s perspective. Cost-effectiveness ratios of VENXR (an SNRI) or fluoxetine (an SSRI) were measured by costs (pharmacy) and effectiveness (patient achieving treatment adequacy).
Materials and Methods: Treatment adequacy was defined using the Health Plan Employer Data and Information Set (HEDIS) Antidepressant Medication Management measures as continuous therapy for 84 or 180 days at a specified dose (75-150 mg/day for VENXR; 20 mg/day for fluoxetine). Data on treatment adequacy were retrospectively obtained using Prescription Solutions data from Medicare health plans. Pharmacy claims were obtained for 90 days prior and 270 days after the index prescription for either VENXR or fluoxetine during the index period (1/1/00-2/28/01). Cohort included patients ³65 years old, newly starting with either VENXR or fluoxetine and remaining on the same medication for 84 or 180 continuous days. Pharmacy costs of VENXR or fluoxetine (generic and branded) were comprised of the daily Average Wholesale Price (AWP) from 2002 Red Book multiplied by the average daily consumption (DACON) from 2002 IMS National Prescription Audit (NPA) Plus. Daily pharmacy costs were then weighted by 2002 IMS market share. Cost per patient achieving treatment adequacy was computed using daily pharmacy costs ($3.97 for VENXR; $3.85 for fluoxetine) and the probability of achieving treatment adequacy for 84 (80% for VENXR [n=295]; 56% for fluoxetine [n=507]; P£0.0001) or 180 continuous days (82% for VENXR [n=217]; 58% for fluoxetine [n=383]; P£0.0001).
Results: Cost per patient achieving treatment adequacy for 84 continuous days for VENXR was $417 versus $578 for fluoxetine. Cost per patient achieving treatment adequacy for 180 continuous days for VENXR was $871 versus $1,195 for fluoxetine.
Conclusion: VENXR is associated with high treatment adequacy rates at both 84 and 180 continuous days. VENXR is a cost-effective antidepressant treatment in terms of cost per patient achieving treatment adequacy in older adults.
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