Reducing the global burden of depression: population-level analysis of intervention cost-effectiveness in 14 world regions.
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.


METHODS
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 significantly if there is a substantial increase substantial increase in treatment coverage.
Chisholm
Dan
D
Department of Health System Financing, Expenditure and Resource Allocation,WHO, Geneva, Switzerland. ChisholmD@who.int
Sanderson
Kristy
K
Ayuso-Mateos
Jose Luis
JL
Saxena
Shekhar
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D002648:Child; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D014943:Global Health; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015995:Prevalence; D016896:Treatment Outcome
D000928:Antidepressive Agents