CURRENT THERAPEUTIC RESEARCH@ VOL. 56, NO. 6, JUNE 1995 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDC ECONOMIC VALUATION OF AMITRIPTYLINE, DESIPRAMINE, NORTRIPTYLINE, AND SERTRALINE IN THE MANAGEMENT OF PATIENTS WITH DEPRESSION TRACY L. SKAER,‘*’ DAVID A. SCLAR,1~3 LINDA M. ROBISON,’ RICHARD S. GALIN,2** RANDALL F. LEGG,3 AND NEIL L. NEMIC3 ‘College of zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Pharmacy , Washington State University, P&mm, 2Pullmun zyxwvutsrqponmlkjihgfedcbaZ Menwrid Hospital, Pullman, %Tenter for Health Services Research & Policy, Qunl-Med Health Plan of W~hi~ton, Inc., Inland No~h~est Division, Spohane, Washington; and 4University of California at Los Angeles Neuro-Psychiatric Institute, Los Angeles, California ABSTRACT zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPO The high prevalence of depression and its associated morbidity, mor- tality, and economic consequence to the health care delivery system and society mandate the selection of both efficacious and effective treatment. Recent pharmacotherapeutic advances in the treatment of patients with depression have included the development of selective serotonin re-uptake inhibitors (SSRIs). The present study was de- signed to contrast direct health service expenditures for the treatment of depression among patients enrolled in a health maintenance orga- nization (HMO) and prescribed either the SSRI sertraline or one of three tricyclic antidepress~ ts (TCAs) (amitriptyline, desipramine, or nortriptyline). Information regarding health service utilization was derived from the computer archive of a network-m~ el HMO system serving 560,000 beneficiaries. A total of 823 HMO beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to discern the incremental influence of selected demographic, clinical, financial, and provider characteristics on l-year post-period expenditures tPPE) for health care. Analysis-of- variance procedures with Duncan’s multiple-range test or chi-square analyses revealed no significant baseline difference across antidepres- sant pharmacotherapy for age, 6-month prior-period expenditures for physician visits, psychiatric visits, laboratory tests, or psychiatric hos- pital services related to the treatment of depression (as defined via International Classification of Diseases, 9th revision, Clinical Moditi- cation or Diagnostic and Statistical Manual of Mental Disordera, 4th edition code 296.21, or number of medications for concomitant disease state processes other than depression. Receipt of sertraline was asso- ciated with a significantly (P G 0.05) higher rate of initial prescribing by psychiatrists and an increase in the number of prescriptions for antidepressant pharmacotherapy obtained (30.day supplies). Multi- variate findings indicate that receipt of a TCA resulted in an increase in the use of physician visits ($101.65; P s 0.05), psychiatric visits Address correspondence to: Tracy L. Skaer, B.Pharm. Pharm.D., Assistant Professor of Pharmacy Practice, College of Pharmacy, Washington State University, Pullman, Was~n~n 991646510. Received for publication on April 12,1995. Printed in the U.S.A. Reproduction in whole or part is not permitted. 556 0011393x/s6/$3.50