Duration of Therapy and Health Care Costs of Fluoxetine, Paroxetine, and Sertraline in 6 Health Plans
J Clin Psychiatry 2002;63(2):156-164
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: Previous studies comparing
fluoxetine, paroxetine, and sertraline, the 3 most common
selective serotonin reuptake inhibitors (SSRIs), in naturalistic
settings have produced conflicting results. With this study, we
provide new evidence as to the similarities and differences among
these SSRI therapies with respect to the duration of use and
health care costs.
Method: Data from 6 health maintenance
organizations were used to identify patients with new-onset major
depression, number of days with filled prescriptions, and total
health care and depression-related costs. The sample consisted of
1771 patients given initial prescriptions for sertraline (N =
386), fluoxetine (N = 840), or paroxetine (N = 545) in the period
from July 1, 1994, to March 31, 1997. Analyses included Cox
proportional hazards models (for duration of initial therapy) and
ordinary least squares regression (for cost).
Results: Patients who initiated therapy with
fluoxetine were more likely to have a later interruption of
therapy than patients who initiated therapy with sertraline (p =
.03) and paroxetine (p = .001). Total 1-year costs did not differ
statistically between the treatment groups, but 1-year
depression-related costs were significantly lower for patients
who initiated therapy with sertraline or paroxetine than for
those who initiated therapy with fluoxetine ($332 less for
sertraline, 95% confidence interval [CI] = $125 to $562; $339
less for paroxetine, 95% CI = $144 to $416).
Limitations: A limitation of this observational
study, as well as of observational studies in general, is that
unobserved characteristics of the patients may lead to biased
estimates of the impact of treatment on adherence or cost, even
with controls for observed characteristics.
Conclusion: We found no significant differences
in total health care costs among the 3 SSRIs, but noted
significant differences in depression-related costs (the costs of
fluoxetine are greater than those of sertraline and paroxetine).
Importantly, there was no relationship between treatment
interruption and increased health care or depression-related
costs, in contrast to the findings of some, but not all, prior