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Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial


Romeo, R., Knapp, M., Hellier, J., Dewey, M., Ballard, C., Baldwin, R., Bentham, P., Burns, A., Fox, C., Holmes, C., Katona, C., Lawton, C., Lindesay, J., Livingston, G., McCrae, N., Moniz-Cook, E., Murray, J., Nurock, S., O'Brien, J., Poppe, M., Thomas, A., Walwyn, R., Wilson, K., Banerjee, S.


The British Journal Of Psychiatry: The Journal Of Mental Science, Volume: 202, Pages.: 121-128

Year of Publication



Background: Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.; Aims: To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.; Method: A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0-13 weeks and 0-39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.; Results: There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.; Conclusions: In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.;

Bibtex Citation

@article{Romeo_2012, doi = {10.1192/bjp.bp.112.115212}, url = {}, year = 2012, month = {dec}, publisher = {Royal College of Psychiatrists}, volume = {202}, number = {2}, pages = {121--128}, author = {R. Romeo and M. Knapp and J. Hellier and M. Dewey and C. Ballard and R. Baldwin and P. Bentham and A. Burns and C. Fox and C. Holmes and C. Katona and C. Lawton and J. Lindesay and G. Livingston and N. McCrae and E. Moniz-Cook and J. Murray and S. Nurock and J. O{textquotesingle}Brien and M. Poppe and A. Thomas and R. Walwyn and K. Wilson and S. Banerjee}, title = {Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial}, journal = {The British Journal of Psychiatry} }


analogs derivatives, antidepressive agents, caregivers, complications, dementia, depression, drug therapy, economics, health care costs, health services for the aged, humans, intention to treat analysis, mianserin, mirtazapine, outcome assessment (health care), placebos, psychiatric status rating scales, quality of life, sertraline, statistics & numerical data, therapeutic use, time factors, utilization

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Economic evaluation, Randomised Controlled Trial

Type of Outcomes

Prevention and/or management of co-morbidities, Quality of Life of Person With Dementia, Service use or cost reductions (incl. hospital use reduction, care home admission delay)

Type of Interventions

Pharmaceutical Interventions

Pharmaceutical Interventions

Antipsychotics and antidepressants