A comparative study on efficacy, safety and cost effectiveness analysis between vortioxetine and escitalopram in major depressive disorder

Abstract

Major depressive disorder (MDD) is a prevalent and debilitating mental health condition. This study aimed to compare the clinical efficacy, safety, and cost-effectiveness of vortioxetine and escitalopram in the treatment of MDD among outpatients at NRI General Hospital, Guntur, Andhra Pradesh. A non-randomised interventional trial was conducted over eight months involving 180 patients diagnosed with MDD based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Participants were equally divided into two groups, one receiving vortioxetine and the other escitalopram monotherapy. Clinical outcomes were assessed using the Hamilton Depression Rating Scale (HAM-D), and safety was evaluated using the World Health Organization (WHO) causality assessment scale. A pharmacoeconomic analysis was conducted using the incremental cost-effectiveness ratio (ICER). Both groups showed significant improvement in HAM-D scores (p < 0.0001), with no statistically significant difference in efficacy between the two treatments, although escitalopram demonstrated slightly greater symptom reduction (mean score reduction: 14.37 vs. 12.7). Vortioxetine, however, was associated with fewer and less severe adverse drug reactions. Cost-effectiveness analysis revealed escitalopram to be more economical than vortioxetine (average cost of ₹2129.44 vs. ₹3448.20 per patient), with a negative ICER indicating it as the more cost effective option. These findings suggest that escitalopram is the more cost-effective antidepressant for MDD treatment in this study setting, while vortioxetine’s favourable safety profile may offer advantages for patients prioritising tolerability, highlighting the importance of individualised treatment selection based on both clinical and economic considerations.