Cost-effectiveness of vortioxetine compared with levomilnacipran and vilazodone in patients with major depressive disorder switching from an initial antidepressant.

Introduction: Many patients with major depressive disorder (MDD) do not achieve remission with their first antidepressant (AD), resulting in a high burden due to treatment failure. Vortioxetine is a valid treatment option for patients with MDD only partially responding to their first AD. Characterization of vortioxetine's potential benefits versus other approved treatments is important. Areas covered: The cost-effectiveness of vortioxetine, including cognitive outcomes, was modeled in comparison with levomilnacipran and vilazodone for patients switched to these medications after inadequate responses to a first AD. Expert opinion: Vortioxetine was associated with incremental quality-adjusted life-year (QALY) gains versus levomilnacipran (0.008) or vilazodone (0.009). Vortioxetine was dominant versus levomilnacipran and cost-effective versus vilazodone (incremental cost-effectiveness ratio [ICER],33,829 USD/QALY). In sensitivity analyses using residual cognitive dysfunction rates (vortioxetine, 49%; levomilnacipran, 58%, and vilazodone, 64%), incremental QALY gains for vortioxetine versus levomilnacipran (0.0085) or vilazodone (0.0109) were found. Vortioxetine remained dominant versus levomilnacipran and cost-effective versus vilazodone (ICER, 27,633 USD/QALY). ICER reduction was found with cognition outcomes inclusion. This model provides additional support for considering vortioxetine for patients requiring a switch of MDD treatments, although its conclusions are limited by the data available for inclusion. Additional research and real-world trials are needed to confirm the findings.

Cost-utility analysis of vortioxetine versus agomelatine, bupropion SR, sertraline and venlafaxine XR after treatment switch in major depressive disorder in Finland.

BACKGROUND: To assess the cost-utility of vortioxetine versus relevant comparators (agomelatine, bupropion SR, sertraline, and venlafaxine XR) in the finnish setting in major depressive disorder (MDD) patients with inadequate response to selective serotonin- /serotonin-norepinephrine reuptake inhibitors. METHODS: A one-year analysis was conducted using a decision tree with a Markov state transition component. The health states were remission, relapse and recovery. A Finnish healthcare payer perspective was adopted. RESULTS: Vortioxetine was less costly and more effective versus all comparators in both direct and societal perspectives. Vortioxetine reduced the average annual direct costs by 4% versus venlafaxine XR and 8% versus sertraline. The greater efficacy associated with vortioxetine was translated into a higher percentage of patients in remission and recovery. The model was most sensitive to changes in remission rates at 8 weeks. CONCLUSION: This cost-utility analysis showed vortioxetine to be a good alternative for MDD patients switching therapy in Finland.

Predictors of costs related to cardiovascular disease among patients with atrial fibrillation in five European countries.

AIMS: To estimate predictors of direct costs and costs of hospitalization related to cardiovascular disease (CVD) in patients with atrial fibrillation (AF) recruited to the Euro Heart Survey on AF (EHS-AF) in Greece, Italy, Poland, Spain, and the Netherlands. METHODS AND RESULTS: Annual direct costs were modelled by country using ordinary least squares (OLS) regression. For costs of hospitalization related to CVD, logistic regressions followed by conditional OLS regression were employed. In each case, effects of the following potential explanatory variables were tested: age, sex, body mass index, type of AF, diabetes, hypertension, myocardial infarction (MI), angina pectoris (AP), valvular heart disease (VHD), congestive heart failure (CHF), stroke, and/or other underlying heart disease at the time of enrolment in the EHS-AF. Estimated direct annual costs for the reference EHS-AF patient (female aged <65 years with first-detected AF and no co-morbidities at baseline) were €933 in Greece, €1383 in Italy, €698 in Poland, €1316 in Spain, and €1544 in the Netherlands. The co-morbidities identified as predictors of direct costs were VHD in Greece, Italy, and Spain, AP in Italy and Spain, diabetes and stroke in Poland, CHF in Italy, MI in Spain and other underlying heart disease in Poland and the Netherlands. For costs of CVD-related hospitalization, the most important co-morbidity identified as a predictor was VHD. CONCLUSION: The results reported in this study increase the understanding of the cost structure of CVD in AF patients and may therefore inform the targeting of intervention therapy in selected groups of at-risk patients.