Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model

PLoS One. 2012;7(8):e42003. doi: 10.1371/journal.pone.0042003. Epub 2012 Aug 2.


Objective: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression.

Design: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine). The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year.

Data sources: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources.

Results: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine.

Conclusion: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

Publication types

  • Meta-Analysis

MeSH terms

  • Antidepressive Agents / economics*
  • Antidepressive Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / economics*
  • Humans
  • Models, Economic*
  • Primary Health Care / economics*
  • Treatment Outcome


  • Antidepressive Agents

Grant support

No external funding was received. In 2008 TLV reviewed the reimbursement status of antidepressants in Sweden and that review was the starting point of the current study, but TLV has not funded the production of the current analyses and manuscript. No external funding has been received from any organization. In particular, neither Innovus nor AstraZeneca Nordic (where two of the authors are employees) have in any way funded the study. The work has been carried out in the authors’ free time without any involvement from these organizations.