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Review: short-term benefit of escitalopram versus citalopram for depression uncertain, but big difference in French health insurance costs

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Question

Question: What is the efficacy of citalopram compared with escitalopram (its chiral switch form) in people with depression, and what is the impact on health insurance costs?

Outcomes: Efficacy (response to treatment defined as 50% decrease in depression score on the Montgomery-Åsberg depression rating scale or Hamilton Scale) at 8 weeks (or closest time point); treatment acceptability (proportion of patients not dropping out during treatment); health insurance costs.

Methods

Design: Systematic review with meta-analysis.

Data sources: The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE via PubMed, EMBASE, UK National Institute for Health and Clinical Excellence, US Agency for Healthcare Research and Quality, German Institute for Quality and Efficiency in Health Care, US Food and Drug Administration (Drugs@FDA database) and the French National Authority for Health were searched from January 2000 to March 2011 for reviews. PubMed and EMBASE were searched for randomised control trials (RCTs) from March 2011 to February 2012. Databases of pharmaceutical company that produced these drugs were searched and the company contacted for clinical trials. A representative sample of the French National Health Insurance Inter-regime Information System (SNIIR-AM) was searched for reimbursement costs between January 2003 and December 2010 (generic citalopram introduced December 2003, and escitalopram introduced …

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