© 2004 The Royal College of Psychiatrists
Reducing the global burden of depression
Population-level analysis of intervention cost-effectiveness in 14 world regions
Department of Health System Financing, Expenditure and Resource Allocation,WHO and Department of Mental Health and Substance Abuse, WHO
School of Public Health, Queensland University of Technology, Australia
Department of Psychiatry, Hospital Universitario de la Princesa,Universidad Autonoma de Madrid, Spain
Department of Mental Health and Substance Abuse,WHO,Geneva
Correspondence: Dan Chisholm,CEP Team (Room 3169), Department of Health System Financing, Expenditure and Resource Allocation, Evidence and Information for Policy,World Health Organization, 1211 Geneva, Switzerland; e-mail: ChisholmD{at}who.int
See pp.
386–392 and
editorial, pp.
379–380, this
issue.
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 I$) 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 DALYaverted 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 significantlyif there is a substantialincrease substantial increase intreatment coverage.
Related articles in BJP:
- Depression: international intervention for a global problem
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BJP 2004 184: 379-380.[Full Text] - Highlights of this issue
BJP 2004 184: 379-a19.[Full Text] - Global burden of depressive disorders in the year 2000
- T. B. Üstün, J. L. Ayuso-Mateos, S. Chatterji, C. Mathers, and C. J. L. Murray
BJP 2004 184: 386-392.[Abstract] [Full Text] - Peter Tyrer
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