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Amitriptyline hydrochloride cost was 4.5 (95% CI 0.6 to 19), and venlafaxine hydrochloride cost was 5.8 (95% CI 1.7 to 21). Conclusions and Relevance There was a tendency for patients treated with serotonin reuptake inhibitors (SRIs) to have a higher cost of health care per patient visit in the second year than patients treated with SSRIs. Trial Registration Identifier: NCT00122812 Introduction Serotonergic antidepressants (SSRIs) are commonly prescribed for depression. A recent systematic review found that among adults with major depression, cost per unit of use (including the first 30 days of use) exceeded $1,250 for SSRIs compared with $851 paroxetine and $788 for venlafaxine.1 As a consequence, it is important to evaluate whether these data can be generalized to the entire antidepressant treatment population, particularly in light of the high cost per visit and the absence of a long-term, double-blind, randomized clinical trial to test the cost–effectiveness of SSRIs versus non–SSRIs.2 This study is a secondary analysis of larger open-label extension trial.3 In our primary analyses, we compared costs for treatment with sertraline hydrochloride, imipramine fluoxetine paroxetine and sertraline hydrochloride, as well with fluoxetine hydrochloride alone. This latter comparison is particularly relevant because recent analysis4 found that the cost–effectiveness comparison between sertraline hydrochloride, imipramine fluoxetine paroxetine and sertraline hydrochloride was not significant. That comparison conducted in patients treated with fluoxetine but not other psychotropic medications. Therefore, the latter comparison could represent a more generalizable comparison of costs that could be tested in a larger, randomized controlled trial. Methods Study Population The study population was a secondary analysis of larger open-label extension study.1 Patients were randomly assigned to receive a trial of fluoxetine hydrochloride (n = 511) or placebo 637) for 8 weeks during which they took the SSRI for 4 weeks as their first available treatment. Patients also received fluoxetine hydrochloride as their second and third available drugs of trial. All doses were given once daily. Patients considered eligible with a score of ≥12 on the Hamilton Depression Rating Scale at the start of this study, that is, no major depressive episode. The baseline data of primary amitriptyline cost australia analysis are currently being collected. The primary analyses included patients who received all available treatments for at least 6 months.

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