What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment.
TL;DR: The model reveals that medication that appears expensive in terms of cost per day may not be so when patient compliance and the total costs of treatment are taken into account.
Abstract: The purpose of this study was twofold: to measure the overall direct costs of depression for 1990 in the UK, and to develop a model to illustrate issues in the evaluation of the relative cost-effectiveness of the pharmacological treatment of depression. We compared a tricyclic antidepressant, imipramine, with paroxetine, a newer antidepressant. For assessing the cost of illness, we used a top-down approach. We calculated direct but not indirect costs. Cost-effectiveness was evaluated by developing a simulation model based on the theory of clinical decision analysis to compare the costs and outcome of each treatment. From this we estimated the expected cost per patient and the cost per successfully treated patient. The total cost to the nation of depressive illness was estimated to be 222 pounds million. The expected costs per patient were found to be similar for paroxetine and imipramine (430 pounds v. 424 pounds). The costs per successfully treated patient were found to be lower for paroxetine (824 pounds) than for imipramine (1024 pounds). The results were stable when a sensitivity analysis was applied to the variables employed in the model. The most sensitive variable was the cost of treatment failure. Our model thus reveals that medication that appears expensive in terms of cost per day may not be so when patient compliance and the total costs of treatment are taken into account.
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TL;DR: In this article, the authors report the results of a 'cost-of-illness' study of the socioeconomic costs of back pain in the UK and report that approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families.
Abstract: This paper reports the results of a 'cost-of-illness' study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be pound1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total pound10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with findings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health benefit from the resources used in this area.
1,385 citations
Karlstad University1, Dresden University of Technology2, Karolinska University Hospital3, Mental Health Services4, Phillips University5, University of Florence6, Karolinska Institutet7, John Radcliffe Hospital8, King's College London9, London School of Economics and Political Science10, Lund University11, Harvard University12, University of Basel13, Norwegian University of Science and Technology14, University of Zurich15, Umeå University16, University of Cambridge17, University of Lausanne18, University of Sassari19, European Monitoring Centre for Drugs and Drug Addiction20, Aalborg University21, Cliniques Universitaires Saint-Luc22, Maastricht University Medical Centre23, Radboud University Nijmegen24, Stockholm School of Economics25
TL;DR: The present report presents much improved cost estimates for the total cost of disorders of the brain in Europe in 2010, covering 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items.
1,325 citations
TL;DR: Evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings.
Abstract: The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.
477 citations
Cites background from "What price depression? The cost of ..."
...the SSRIs and nefazadone hydrochloride should improve depressive symptoms and quality of life because of greater patient adherence to treatment with the drugs.(33-37) These studies estimated overall treatment costs for SSRIs to be no greater (or even lower) than those of TCAs....
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TL;DR: Depression is associated with a high economic burden and conducting COI-studies of depression along the line noted in the review could help provide the opportunity to expose differences in costs associated with different approaches to disease management.
321 citations
TL;DR: The shift to community-based management for depression alongside the availability of more accurate data have allowed these estimates to be revised, resulting in a total cost of adult depression in England during 2000 of over pound 9 billion.
Abstract: Background The cost of depression in the UK was estimated at £ 3.5 billion almost a decade ago. The shift to community-based management for depression alongside the availability of more accurate data have allowed these estimates to be revised.
Aims To calculate the total cost of depression in adults in England during 2000.
Method Recorded data on health service use by patients with depression were analysed and the cost of treating patients was calculated. The cost of working life lost was estimated from sickness benefit claims and the number of registered deaths of patients with depression.
Results The total cost of adult depression was estimated at over £ 9 billion, of which £370 million represents direct treatment costs. There were 109.7 million working days lost and 2615 deaths due to depression in 2000.
Conclusions Despite awareness campaigns and the availability of effective treatments, depression remains a considerable burden on both society and the individual, especially in terms of incapacity to work.
311 citations
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01 Jan 1998
TL;DR: The second edition of the first edition of this book was published in 1987 as discussed by the authors, and the second edition includes new chapters on collection and analysis of data and on the presentation and use of data.
Abstract: We are witnessing a paradigm shift in the way medicine is practiced, taught, and evaluated. It was relatively recently that medicine knew no limits. New diagnostic procedures led to more medical and surgical procedures and to greater expense. It was assumed that patients would be the recipient of these advances. However, the uncontrolled costs of medical care and the poor documentation of patient benefit ushered in a new era of cost conscientiousness. Now, there is a need to show that medicine produces value for money. As a result, new methodologies such as cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis have become commonplace in medical journals. This has created a need to revise medical education and postgraduate training in order to accommodate new methodologies and new controversies. Within the last few years, several influential publications have emerged. Perhaps the most important of these is the book Cost-Effectiveness in Health and Medicine edited by Martha Gold and colleagues.1 This book summarizes the consensus of an expert panel convened to review cost-effectiveness analysis in health care. The Gold book covers the theory but does not teach the methods. Methods for the Economic Evaluation of Health Care Programmes by Michael Drummond and colleagues offers specific, step-by-step methodologies for conducting economic evaluations. This is the second edition of a book originally published in 1987. During the ten years between editions, there were very substantial advances in theory and methods for economic evaluations of health care programs. The revised edition brings the text up to date. Methods for the Economic Evaluation of Health Care Programmes arises from the teaching of health economics at McMaster University. The McMaster Centre for Health Economics and Policy Analysis is internationally regarded as a focal point for economic evaluations of health care. Among other advances, researchers at the Centre have produced a widely used methodology, known as the Health Utilities Index, for estimating the cost/utility of health programs. The book was originally developed for a course at McMaster and for a workshop offered by the McMaster faculty. The second edition adds one new author (Bernie O’Brien) who has more recently joined the McMaster faculty. The second edition also introduces substantial changes in the chapters on cost-effectiveness, cost-utility, and cost-benefit analysis. These are important improvements because of the profound methodological developments in these areas. In addition, the second edition includes new chapters on collection and analysis of data and on the presentation and use of data. These new chapters add discussion on the pros and cons of economic evaluations and on some of the difficulties in the interpretation of economic data. In addition, the second edition includes many more boxes and illustrations to facilitate the interpretation of the text. Perhaps the greatest contribution of the book is the very detailed presentation of cost/utility analysis. It is now common to offer discussions of the cost to produce a year of life adjusted for life quality. This is known as a quality adjusted life year (QALY). There are a variety of different methods for estimating QALYs. Nevertheless, QALYs estimated using different methods are often found in the same comparison or “league” table. This book goes into considerable detail in how QALYs are estimated and describes some of the methodological issues and problems in estimating these outcomes. Unlike other texts, the book provides systematic stepby-step instruction in how both costs and health benefits can be estimated. In summary, the role of health economics is becoming firmly established in the evaluation of health care programs. In combination with Gold and colleagues’ book,1 which provides a detailed theoretical discussion of economic analysis, Methods for the Economic Evaluation of Health Care Programmes offers systematic training in the application of economic methodologies. This book can serve as a basic text for students hoping to understand the complex methodologies of economic evaluation. In addition, the book is a handy reference for advanced practitioners of economic analysis.
6,537 citations
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01 Nov 1990
1,842 citations
TL;DR: These economic figures provide a lower-bound estimate of the full economic burden of major depression and further emphasize the need for timely recognition and treatment to potentially minimize the negative impact of the illness on society.
726 citations