Cost-effectiveness of vortioxetine versus venlafaxine (extended release) in the treatment of major depressive disorder in South Korea

ABSTRACTObjective: To assess the cost-effectiveness of vortioxetine versus venlafaxine XR (extended-release) in major depressive disorder (MDD) patients in South Korea.Methods: A 1-year cost-effectiveness analysis from a limited societal perspective was performed using a combined model consisting of a decision-tree and a Markov model. Patients entered the model when initiating or switching antidepressant treatment following inadequate response to previous treatment. Remission, relapse and recovery were the main health states.Results: Vortioxetine dominated venlafaxine XR, with quality-adjusted life year (QALY) gains of 0.0131 and cost savings of KRW 623,229/year [US$530/year] from a limited societal perspective. Safety contributed more than efficacy to the incremental QALY gains. More patients were in recovery after initial treatment and after 1 year with vortioxetine (31%, 40%) compared to venlafaxine XR (23%, 36%). Vortioxetine remained dominant in 98% of probabilistic simulations.Conclusion: Vortioxetine dominated venlafaxine XR in South Korea and is a relevant treatment option for MDD patients initiating or switching therapy.摘要 研究目的：评估韩国重度抑郁症（major depressive disorder, MDD）患者使用伏硫西汀与文拉法辛缓释剂（venlafaxine XR, extended-release）的成本-效果比。 研究方法：采用决策树与马尔可夫（Markov）模型联用的复合模型，从受限社会视角开展为期1年的成本-效果分析。研究纳入既往抗抑郁治疗应答不佳后启动或更换抗抑郁治疗的患者作为研究对象，主要健康状态包括症状缓解、疾病复发与临床康复。 研究结果：从受限社会视角来看，伏硫西汀相较于文拉法辛缓释剂具有成本-效果占优，其质量调整生命年（quality-adjusted life year, QALY）增益为0.0131，每年可节省医疗成本623229韩元[约合530美元]。安全性对增量QALY增益的贡献度高于疗效。伏硫西汀组在初始治疗结束后及治疗1年时的临床康复患者占比（分别为31%、40%）均高于文拉法辛缓释剂组（分别为23%、36%）。在98%的概率敏感性模拟中，伏硫西汀仍保持成本-效果占优。 研究结论：在韩国人群中，伏硫西汀相较于文拉法辛缓释剂具有成本-效果优势，可作为重度抑郁症患者启动或更换抗抑郁治疗的适宜治疗选择。