Policy Analysis for Depression Management At Low &Middle income countries (original) (raw)
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Depression: cost-of-illness studies in the international literature, a review
The Journal of Mental Health Policy and Economics, 2000
Background: Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well-being. Aims of the study: The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries. Methods: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. Results: 110 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in-depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for £417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. Discussion: Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries such as France, Germany, Spain, Japan and others. Implication for health care provision and use: The high incidence of hospitalization, and the finding that drug cost represents only a minor component of the total direct cost of the disease, suggests that room is still available for disease management strategies that, while effectively managing the patient's clinical profile, could also improve health economic efficiency. Implication for health policies: Disease management strategies, with particular emphasis on education, should be targeted not only at patients and medical professionals but also at health decision makers in order 'to encourage effective prevention and treatment of depressive illness'. Implications for further research: Cost of illness studies are a very useful tool allowing cost data comparisons across countries and diseases: for this reason, we suggest that further research is needed especially in some western European countries to assess the true economic burden of depression on societies. Copyright
Model to assess the cost-effectiveness of new treatments for depression
International Journal of Technology Assessment in Health Care, 2006
Objectives: The objective of this study was to develop a model to assess the cost-effectiveness of a new treatment for patients with depression.Methods: A Markov simulation model was constructed to evaluate standard care for depression as performed in clinical practice compared with a new treatment for depression. Costs and effects were estimated for time horizons of 6 months to 5 years. A naturalistic longitudinal observational study provided data on costs, quality of life, and transition probabilities. Data on long-term consequences of depression and mortality risks were collected from the literature. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from the new treatment compared with standard care, and the societal perspective was taken. Probabilistic analyses were conducted to present the uncertainty in the results, and sensitivity analyses were conducted on key parameters used in the model.Results: Compared with standard care, the new hypothetica...
Determinants of access to health care for depression in 49 countries: A multilevel analysis
Journal of affective disorders, 2018
The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27....
Using epidemiological data to model efficiency in reducing the burden of depression
The Journal of Mental Health Policy and Economics, 2000
The Global Burden of Disease study has suggested that mental disorders are the leading cause of disability burden in the world. This study takes the leading cause of mental disorder burden, depression, and trials an approach for defining the present and optimal efficiency of treatment in an Australian setting. Aims of the Study: To examine epidemiological and service use data for depression to trial an approach for modelling (i) the burden that is currently averted from current care, (ii) the burden that is potentially avertable from a hypothetical regime of optimal care, (iii) the efficiency or cost-effectiveness of both current and optimal services for depression and (iv) the potential of current knowledge for reducing burden due to depression, by applying the WHO five-step method for priorities for investment in health research and development. Methods: Effectiveness and efficiency were calculated in disability adjusted life years (DALYs) averted by adjusting the disability weight for people who received efficacious treatment. Data on service use and treatment outcome were obtained from a variety of secondary sources, including the Australian National Survey of Mental Health and Wellbeing, and efficacy of individual treatments from published meta-analyses expressed in effect sizes. Direct costs were estimated from published sources. Results: Fifty-five percent of people with depression had had some contact with either primary care or specialist services. Effective coverage of depression was low, with only 32% of cases receiving efficacious treatment that could have lessened their severity (averted disability). In contrast, a proposed model of optimal care for the population management of depression provided increased treatment contacts and a better outcome. In terms of efficiency, optimal care dominated current care, with more health gain for less expenditure (28 632 DALYs were averted at a cost of AUD295 million with optimal care, versus 19 297 DALYs averted at a cost of AUD720 million with current care). However, despite the existence of efficacious technologies for treating depression, only 13% of the burden was averted from present active treatment, primarily because of the low effective coverage. Potentially avertable burden is nearly three times this,
Cost of Mental Illness and Depression in Developing Countries: A Case Study of Pakistan
Journal of education and social studies, 2022
Depression causes a substantial burden to persons, their beloved ones, and the nations as a whole. Major depression results in disability, high morbidity, high mortality, suicides, physical and mental impairment, and deteriorates the quality of life in a society. Depression is common in developing countries like Pakistan. This study analyzes the economic burden of depression and depressive disorders in Pakistan. The study was conducted in Pakistan's third largest city, Faisalabad. Respondents were selected using a multistage sampling technique. As a first step, hospitals were selected from both the public and private sectors. In step two, respondents were selected and interviewed using a well-structured and pre-tested questionnaire. Review of literature reveals that the largest share of the burden of depression and depressive disorders is in the form of indirect cost. Direct healthcare cost is mostly in the form of outpatient care, doctor fee, and medicine bills, etc. This study, therefore, estimated both types of costs using cost of illness (COI) analysis. In order to find out the level of depression in patients, the center of epidemiologic studies depression (CES-D) scale was used. Then the direct and indirect cost of depression was estimated. Additionally, multiple regression analysis was used to examine the determinants of health cost, including the level of depression. The direct and indirect costs of depression were 11,108 Pakistani Rupees (PKR) and 4,869 PKR per month, respectively. Results of regression analysis revealed that besides the level of depression, monthly income, age, education, and the number of visits to a doctor's clinic determine health cost, positively and statistically significant. Additionally, the occurrence of depression and anxiety was evident in adults more than other age groups. Females were suffering from this disorder comparatively more than male respondents. The economic burden related to depression is considerable, especially for those who belong to low-income group. Government should provide facilities for treatment for depression in public hospitals by keeping a special focus on less privileged groups of the population.
International Journal of Methods in Psychiatric Research, 2001
Background. Screening surveys of depressive symptoms were conducted among primary care patients at six sites in different countries. The LIDO Study was designed to assess quality of life and economic correlates of depression and its treatment in culturally diverse primary health care settings. This paper describes : (1) the association between depressive symptoms and functional status, global health-related quality of life (QoL), and use of general health services across different cultural settings ; and (2) among subjects with depressive symptoms, the factors associated with recent treatment for depression. Methods. Subjects aged 18 to 75 were recruited from participating primary care facilities in Be'er Sheva (Israel), Porto Alegre (Brazil), Melbourne (Australia), Barcelona (Spain), St Petersburg (Russian Federation) and Seattle (USA). Depressive symptoms were measured using the CES-D. Also administered were the SF-12, global questions on QoL, selected demographic and social measures, and questions on recent treatment for depression, use of health care services, and lost workdays. Results. A total of 18 489 patients were screened, of whom 37 % overall (range 24-55 %) scored 16 on the CES-D and 28 % (range 17-42 %) scored 20. Overall, 13 % reported current treatment for depression (range 4 to 23 %). Patients with higher depressive symptom scores had worse health, functional status, QoL, and greater use of health services across all sites. Among those with a CES-D score 16, subjects reporting treatment for depression were more likely than those reporting no treatment to be dissatisfied with their health (except in St Petersburg), and to have higher depressive symptom scores. Conclusions. Higher depressive symptom scores in primary care patients were consistently associated with poorer health, functional status and QoL, and increased health care use, but not with demographic variables. The likelihood of treatment for depression was associated with perceptions of health, as well as severity of the depression.
Prevalence and Predictors of Depression Treatment in an International Primary Care Study
American Journal of Psychiatry, 2004
The purpose of the study was to evaluate the prevalence and predictors of depression treatment in a diverse crossnational sample of primary care patients. Method: At primary care facilities in six countries (Spain, Israel, Australia, Brazil, Russia, and the United States), a two-stage screening process was used to identify 1,117 patients with current depressive disorder. At baseline, all patients completed a structured diagnostic interview as well as measures of anxiety symptoms, alcohol use, chronic comorbid physical conditions, and perceived barriers to treatment. Primary care physicians were advised if the research interview indicated a probable depressive disorder in their patients. Three and 9 months later, participants reported all health services (including specialty mental health care and antidepressant medication) used in the preceding 3 months. Results: Across the six sites, the proportion of patients receiving any antidepressant pharmacotherapy ranged from a high of 38% in Seattle to a low of 0% in St. Petersburg; the proportion receiving any specialty mental health care varied from a high of 29% in Melbourne to a low of 3% in St. Petersburg. Patient characteristics were not consistently associated with receipt of either pharmacotherapy or specialty mental health care. Out-of-pocket cost was the most commonly reported barrier to treatment for depression; the percentage of patients who reported this barrier ranged from 24% in Barcelona to 75% in St. Petersburg. Conclusions: Depression screening and physician notification are not sufficient to prompt adequate treatment for depression. The probability of treatment may be more influenced by characteristics of health care systems than by the clinical characteristics of individual patients. Financial barriers may be more important than stigma as impediments to appropriate care.
Medication rationality in treating depression
Acta medica Lituanica, 2011
Background. The costs of depression treatment in Lithuania increase because of high depression relapse rates which indicate the necessity to evaluate first-time depression treatment rationality. The aim of this study was to evaluate the use of antidepressants according to the opinion of three groups of specialists (family doctors, psychiatrists and pharmacists) in order to assess the possibilities of a more rational use of depression treatment costs rationalizing opportunities. Materials and methods. Data on depression diagnoses were obtained from the Republic Psychiatric Health Centre. In 2009, 361 Lithuanian pharmacist, 317 family doctors and 280 psychiatrists were interviewed. The data were processed using the Statistical Package for the Social Sciences program. Results. In the study period (2004–2009), the volume of total depression diagnoses grew up by 12% and the number of relapsed depression diagnoses by 27%. Among family doctors, 13% still don’t launch depression treatment b...
Economic burden of major depressive disorder: a case study in Southern Iran
BMC Psychiatry
Background Depression disorders are a leading cause of disability in the world which imposes a significant economic burden on patients and societies The present study aimed to determine the economic burden of Major Depressive Disorder (MDD) on the patients referred to the reference psychiatric single-specialty hospitals in southern Iran in 2020. Methods This cross-sectional research is a partial economic evaluation and a cost-of-illness study conducted in southern Iran in 2020. A total of 563 patients were enrolled through the census method, and a researcher-made data collection form was used to gather the required information. The prevalence-based and the bottom-up approaches were also used to collect the cost information and calculate the costs, respectively. The data on direct medical, direct non-medical, and indirect costs were obtained using the information in the patients’ medical records and insurance bills as well as their self-reports or those of their companions. To calcul...