Cost-effectiveness of improved primary care treatment of depression in women in Chile.
BACKGROUND
Low- and middle-income countries lack information on contextualised mental health interventions to aid resource allocation decisions regarding healthcare.


OBJECTIVE
To undertake a cost-effectiveness analysis of treatments for depression contextualised to Chile.


METHODS
Using data from studies in Chile, we developed a computer-based Markov cohort model of depression among Chilean women to evaluate the cost-effectiveness of usual care or improved stepped care.


RESULTS
The incremental cost-effectiveness ratio (ICER) of usual care was I$113 per quality-adjusted life-year (QALY) gained, versus no treatment, whereas stepped care had an ICER of I$468 per QALY versus usual care. This compared favourably with Chile's per-capita GDP. Results were most sensitive to variation in recurrent episode coverage, marginally sensitive to cost of treatment, and insensitive to changes in health-state utility of depression and rate of recurrence.


CONCLUSIONS
Our results suggest that treatments for depression in low- and middle-income countries may be more cost-effective than previously estimated.
Siskind
Dan
D
Queensland Center for Mental Health Research, University of Queensland School of Population Health and Division of Mental Health, Princess Alexandra Hospital, Brisbane, Australia. dan_siskind@qcmhr.uq.edu.au
Araya
Ricardo
R
Kim
Jane
J
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002677:Chile; D002908:Chronic Disease; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003865:Major Depressive Disorder / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D059066:Gross Domestic Product; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D011320:Primary Health Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D012008:Recurrence
D000928:Antidepressive Agents