Cost Effectiveness of Fluvoxamine versus Desvenlafaxine among the Patients with Major Depressive Disorder in China

Abstract

Objectives : To estimate the cost effectiveness of fluvoxamine against desvenlafaxine in Chinese patients with major depressive disorder (MDD). Methods : A cost effectiveness of treating Chinese patients with MDD for 6 months maintenance period has been estimated by a decision tree model. The relative effectiveness on relapse rates came from a recent network meta analysis by Kishi et al. (2023) along with local drug cost data based on WHO defined daily dose (DDD) and relapse cost for the 6 months estimated from various sources were used in the model. Based on the Quality Adjusted Life Years (QALY) gain reported by Sobocki et al. (2007), QALY loss from a relapse was estimated. Univariate sensitivity analyses were presented by a Tornado diagram and extensive probabilistic sensitivity analysis based on 10,000 simulations was performed. The most recent cost effectiveness threshold of 1.5 times GDP suggested by Cai et al. (2022) was applied. Results : Fluvoxamine dominated desvenlafaxine (cost savings of 4003 CNY and 0.01 QALY higher in 6 months). The most sensitive parameters were relapse rates followed by desvenlafaxine cost and utility loss of relapse. However, the default result of fluvoxamine dominance was not changed for any univariate sensitivity analysis. The probabilistic sensitivity result showed the cost effectiveness acceptability at 1.5 times GDP as 99.93%. Conclusions : The cost effectiveness of fluvoxamine against desvenlafaxine among Chinese patients with MDD in a 6-month maintenance period was cost saving with better effectiveness ( i.e. , dominating) with low uncertainty.