COST EFFECTIVENESS OF VORTIOXETINE VERSUS DULOXETINE IN ADULTS WITH MAJOR DEPRESSIVE DISORDER
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1
Lundbeck (Denmark), Denmark
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2
Synergy Health Economics Limited, United Kingdom
OBJECTIVES: To estimate the cost-effectiveness of vortioxetine versus duloxetine in adults with moderate to severe major depressive disorder (MDD) and self-reported cognitive symptoms in Norway.
METHODS: The study investigates the cost-effectiveness of vortioxetine (10-20 mg daily dose) versus duloxetine (60 mg daily dose) in Norway for the treatment of adults with moderate to severe MDD and self-reported cognitive symptoms over an 8-week treatment period. Cost-effectiveness was assessed as cost per successfully treated patient (STP), with the definition of a STP being a dual responder (≥ 50% decrease from baseline in Montgomery–Åsberg Depression Rating Scale (MADRS) total score and change in the UCSD Performance-based Skills Assessment (UPSA) score of ≥ 7) in the CONNECT study (NCT 01564862).(1) The use of the dual response endpoint addresses the fact that treatment success for MDD should not just focus on addressing mood symptoms but ultimately functional recovery. Only drug costs were included in the analysis. The base case analysis included costs using the pharmacy retail price for branded vortioxetine (Brintellix®) and branded duloxetine (Cymbalta®) in Norway.(2)
RESULTS: There were more STPs with vortioxetine than duloxetine (27.4% versus 22.5%) after 2 months of treatment. Total drug costs over the 8-week treatment period were Norwegian Kroner (NOK) 894 for vortioxetine and NOK 745 for duloxetine. This was based on a mean dose of 16.0 mg/day for vortioxetine, i.e. 40% of vortioxetine doses at 10 mg/day and 60% of vortioxetine doses at 20 mg/day. The mean cost per STP was lower for vortioxetine than for duloxetine (NOK 3264 versus NOK 3310), with an incremental cost per STP for vortioxetine versus duloxetine of NOK 3051. A scenario analysis using a more challenging change in the UPSA score from baseline (≥ 9) in the dual response endpoint resulted in a mean cost per STP of NOK 3822 for vortioxetine compared with NOK 3983 for duloxetine. This scenario resulted in an incremental cost per STP of NOK 3181 for vortioxetine versus duloxetine.
A scenario analysis which excluded patients whose baseline UPSA score did not enable them to be classified as a responder at the respective threshold due to ceiling effects resulted in mean costs per STP of NOK 2942 and NOK 2967 for vortioxetine and duloxetine respectively, with an incremental cost per STP of NOK 2821 for vortioxetine versus duloxetine. Sensitivity analysis assessed the impact of changes in key parameters on the results. Changes in the price of vortioxetine had the greatest impact on the results. When using the price for vortioxetine 10 mg for vortioxetine 20 mg as well, vortioxetine dominated duloxetine i.e. was less costly and more effective. When using the price for vortioxetine 20 mg for vortioxetine 10 mg as well, the incremental cost per STP for vortioxetine versus duloxetine increased to NOK 6183. The use of generic duloxetine did not have any impact on the results as the price of branded and generic duloxetine is the same in Norway.
CONCLUSIONS: The analysis shows that vortioxetine may be a cost-effective alternative to duloxetine in Norway. This is due to its effect not just on depressive symptoms relief but also on functional recovery.
References
1. Mahableshwarkar AR, Zajecka J, Jacobson W, et al. A randomized, placebo-controlled, active-reference, double-blind, flexible-dose study of the efficacy of vortioxetine on cognitive function in major depressive disorder. Neuropsychopharmacology. 2015;22(8):2025–2037.
2. Statens legemiddelverk, https://www.legemiddelsok.no/ (last accessed 30 March 2017).
Keywords:
Vortioxetine,
cost-effectiveness analysis,
Major Depressive Disorder,
functional recovery,
duloxetine
Conference:
ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017.
Presentation Type:
Poster
Topic:
Population health / economics
Citation:
Christensen
M and
Munro
V
(2019). COST EFFECTIVENESS OF VORTIOXETINE VERSUS DULOXETINE IN ADULTS WITH MAJOR DEPRESSIVE DISORDER.
Front. Psychiatry.
Conference Abstract:
ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future.
doi: 10.3389/conf.fpsyt.2017.48.00011
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Received:
26 May 2017;
Published Online:
25 Jan 2019.
*
Correspondence:
Dr. Michael Cronquist Christensen, Lundbeck (Denmark), Copenhagen, Denmark, mcrc@lundbeck.com