Christopher M. O'Connor, MD; Alexander H. Glassman, MD; and David J. Harrison, PhD
Background: The prevalence of major depressive
disorder in patients with acute coronary syndromes (ACSs) is high
and associated with worse cardiovascular outcomes and higher
health care costs. Sertraline is the only treatment for major
depressive disorder studied in a placebo-controlled trial of
patients with ACS and found to be safe and effective. The cost
implications of providing antidepressant treatment in this
population have not yet been examined. The objective was to
evaluate from a payer perspective the potential reduction in
costs and psychiatric and cardiovascular events and procedures
following sertraline versus placebo treatment of major depressive
disorder in patients hospitalized for ACS.
Method: Data were analyzed from a randomized,
double-blind, placebo-controlled 24-week trial (Sertraline
Antidepressant Heart Attack Randomized Trial) of sertraline
treatment for major depressive disorder in patients hospitalized
for ACS. Main outcome measures included frequency and costs
(derived from Medicare diagnosis-related group fee schedules) of
psychiatric and cardiovascular events occurring during the
treatment period.
Results: There was a trend toward significantly
fewer psychiatric or cardiovascular hospitalizations in the
sertraline compared with the placebo group (55/186 vs. 76/183; p
= .054). The mean per patient cost associated with psychiatric
and medical events over the course of treatment was $2733 for
sertraline and $3326 for placebo, but the difference was not
statistically significant (p = .32). After including the costs of
the sertraline ($360 over 24 weeks), there was no increase in
treatment costs for sertraline compared with placebo.
Conclusion: Sertraline treatment of major
depressive disorder following hospitalization for a recent
myocardial infarction or unstable angina appears to be a
cost-effective strategy.
J Clin Psychiatry 2005;66(3):346-352
© Copyright 2005 Physicians Postgraduate Press, Inc.