Article Text

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

Statistics from


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.


Design: Systematic review with meta-analysis.

Data sources: A systematic review of reviews and randomised controlled trials (RCTS) was carried out; see online notes for details. 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 in June 2005).

Study selection and analysis: RCTs assessing the efficacy of citalopram or escitalopram as a head-to-head comparison or versus placebo in adults with major depression were selected. Random effects meta-analyses were performed using STATA software. Separate meta-analyses were performed for head-to-head comparisons and indirect comparisons using placebo controlled trials. The monthly number of reimbursements for citalopram, generic citalopram and escitalopram were calculated in Defined …

View Full Text


  • Alkhafaji AA, Trinquart L, Baron G, et al. Impact of evergreening on patients and health insurance: a meta analysis and reimbursement cost analysis of citalopram/escitalopram antidepressants. BMC Med 2012;10:142.

  • Correspondence to Philippe Ravaud, Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, 1 place du parvis Notre Dame, Paris, 75004, France;

  • Sources of funding: No funding provided.

  • Competing interests: None.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.