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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: 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 …

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Footnotes

  • 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; philippe.ravaud@htd.aphp.fr

  • Sources of funding: No funding provided.

  • Competing interests: None.

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