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What Price Depression?

The Cost of Depression and the Cost-Effectiveness of Pharmacological Treatment

Published online by Cambridge University Press:  02 January 2018

Bengt Jönsson*
Affiliation:
Centre for Health Economics, Department of Economics, Stockholm School of Economics, Stockholm, Sweden
Paul E. Bebbington
Affiliation:
MRC Social and Community Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
*
Correspondence

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 million. The expected costs per patient were found to be similar for paroxetine and imipramine (£430 v. £424). The costs per successfully treated patient were found to be lower for paroxetine (£824) than for imipramine (£1024). 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.

Type
Papers
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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References

Bebbington, P. E. (1987) Marital status and depression: a study of English national admission statistics. Acta Psychiatrica Scandinavica, 75, 640650.Google Scholar
Bridges, K. & Goldberg, D. (1988) Somatic presentations of psychiatric illness in primary care setting. Journal of Psychosomatic Research, 32, 137144.Google Scholar
Drummond, M. F., Stodderd, G. L. & Torrance, G. W. (1982) Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford Medical Publications.Google Scholar
Dunbar, G. C., Cohn, J. B., Fabre, L. F., et al (1991) A comparison of paroxetine, imipramine and placebo in depressed outpatients. British Journal of Psychiatry, 159, 394398.Google Scholar
Fadden, G. B., Bebbington, P. E. & Kuipers, L. (1987a) The burden of care: the impact of functional psychiatric illness on the patient's family. British Journal of Psychiatry, 150, 285292.Google Scholar
Fadden, G. B., Kuipers, L. & Bebbington, P. E. (1987b) Caring and its burdens: a study of the relatives of depressed patients. British Journal of Psychiatry, 151, 660667.Google Scholar
Freeung, P., Rao, B. M., Paykel, E. S., et al (1985) Unrecognized depression in general practice. British Medical Journal, 290, 18801883.Google Scholar
Hatziandreu, E., Turner, R., Revicki, D., et al (1992) Cost-utility analysis of maintenance treatment for recurrent depression in the UK. Paper presented at the Second Workshop on Costs and Assessment in Psychiatry: the Costs of Affective Disorders, Venice, 26–28 October, 1992.Google Scholar
Hodgson, T. A. (1989) Cost of illness studies: no aid to decision making? Health Policy, 11, 5760.Google Scholar
Hodgson, T. A. & Meiners, M. R. (1982) Cost-of-Illness methodology: A guide to current practices and procedures. Millbank Memorial Fund Quarterly/Health and Society, 60, 429491.Google Scholar
Hurry, J., Bebbington, P. E. & Tennant, C. (1987) Psychiatric symptoms and social disablement as determinants of illness behaviour. Australian and New Zealand Journal of Psychiatry, 21, 6874.Google Scholar
Jönsson, B. (1983) Review of the macro-economic evaluation of cimetidine. In Economic Evaluation of Health Technologies (eds Culyer, A. J. & Horisberger, B.), pp. 241261. Berlin: Springer.Google Scholar
Jönsson, B. & Carlsson, P. (1991) The effects of cimetidine on the cost of ulcer disease in Sweden. Social Science and Medicine, 33, 275282.Google Scholar
Jönsson, B. & Bebbington, P. (1993) Economic studies of the treatment of depressive illness. In Health Economics of Depression (eds Jönsson, B. & Rosenbaum, J.), pp. 3548. Chichester: Wiley.Google Scholar
Kind, P. & Sorensen, J. (1993) The costs of depression. International Clinical Psychopharmacology, 7, 191195.Google Scholar
Klerman, G. L. (1988) The current age of youthful melancholia: evidence for increase in depression among adolescents and young adults. British Journal of Psychiatry, 152, 414.CrossRefGoogle ScholarPubMed
Kramer, M., Brown, H., Skinner, M., et al (1987) Changing living arrangements in the population and their potential effect on the prevalence of mental disorder: Findings of the East Baltimore mental health survey. In Psychiatric Epidemiology: Progress and Prospects (ed. Cooper, B.), pp. 326. London: Croom Helm.Google Scholar
Lönnqvist, J., Sintonen, H., Appleberg, B., et al (1992) Moclobemide and fluoxetine in depression: impact on quality of life and costs. Paper presented at the Second Workshop on Costs and Assessment in Psychiatry: the Costs of Affective Disorders, Venice, 26–28 October, 1992.Google Scholar
McCombs, J. S., Nichol, M. B., Stimmel, G. L., et al (1990) The cost of antidepressant drug therapy failure: A study of antidepressant use patterns in a Medicaid population. Journal of Clinical Psychiatry, 51, 6069.Google Scholar
Mehrez, A. & Gafni, A. (1989) Quality-adjusted life years, utility theory and health-years equivalents. Medical Decision Making, 9, 142149.Google Scholar
Paykel, E. S., Weissman, M. M. & Prusoff, B. S. (1978) Social maladjustment and severity of depression. Comprehensive Psychiatry, 19, 121128.Google Scholar
Prescription Pricing Authority, Department of Health (1988) Prescription Cost Analysis System. London: HMSO.Google Scholar
Rice, D. P. (1992) Conceptual and estimation issues related to cost of illness studies. Paper presented at the Second Workshop on Costs and Assessment in Psychiatry: the Costs of Affective Disorders, Venice, 26–28 October, 1992.Google Scholar
Robins, L. N. & Regier, D. A. (1991) Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press.Google Scholar
Sartorius, N. (1975) Epidemiology of depression. WHO Chronicle, 29, 423427.Google Scholar
Schwab, J. J., Bell, R. A., Warheit, G. J., et al (1979) Social Order and Mental Health: The Florida Health Study. New York: Brunner/Mazel.Google Scholar
Shiell, A., Gerard, K. & Donaldson, C. (1987) Cost of illness studies: an aid to decision-making? Health Policy, 8, 317323.Google Scholar
Sono, F., Freemantle, N., Shelton, T. A., et al (1993) Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. British Medical Journal, 306, 683687.Google Scholar
Stoudemire, A., Frank, R., Hedemark, N., et al (1986) The economic burden of depression. General Hospital Psychiatry, 8, 387394.Google Scholar
Weinstein, M. C. & Fineberg, H. V. (1980) Clinical Decision Analysis. Philadelphia: W.B. Saunders.Google Scholar
Weissman, M., Prussoff, B., Thompson, W., et al (1978) Social adjustment by self report in a community sample and in psychiatric out-patients. Journal of Nervous and Mental Disease, 166, 317376.Google Scholar
West, R. (1992) Depression. London: Office of Health Economics.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. Geneva: WHO.Google Scholar
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