Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions
Chisholm, D and Sanderson, Kristy and Ayuso-Mateos, JL and Saxena, S, Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions, British Journal of Psychiatry, 184 pp. 393-403. ISSN 0007-1250 (2004) [Refereed Article]
Background: International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or 1$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10-30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALY averted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantly if there is a substantial increase in treatment coverage.