Reducing the global burden of depression
Population-level analysis of intervention cost-effectiveness in 14 world regions
Dan Chisholm, Kristy Sanderson, Jose Luis Ayuso-Mateos, Shekhar Saxena

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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.

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