wow-inequalities/02-data/intermediate/wos_sample/2bb61f0ad0767dad03bfed42fa97a6eb-del-carmen-lara-muno/info.yaml

abstract: 'Introduction

  Depression is a public health problem that carries substantial costs for

  the individual and the society. In order to establish evidence-based

  priorities for resource allocation in mental health care, it is

  necessary to integrate the costs and effectiveness of interventions and

  specify the essential packages for their treatment.

  The following are pioneering studies of cost-effectiveness for the

  treatment of depression: 1. compared psychopharmacology options

  (fluoxetine, imipramine and desipramine) to found no difference between

  drugs in terms of clinical efficacy, effect on quality of life and

  costs, and 2. evaluated cost-effectiveness of collaborative program of

  stepped care in primary care of persistent depression, to demonstrate a

  substantial increase in the effectiveness and additional moderate cost

  increase in comparison with usual treatment.

  Recently, the World Health Organization convened the National Institute

  of Psychiatry Ramon de la Fuente, as a collaborating center, to

  participate in the ``Selecting interventions that are

  cost-effective{''''}. labeled WHO-CHOICE (CHOosing Interventions that are

  Cost-Effective).

  This paper presents the findings of the evaluation of cost-effectiveness

  of different clinical interventions for the treatment of depression in

  Mexico, considering its implementation in primary care services.

  Method

  The cost-effectiveness unit of measure gathered by WHO (and used in this

  work) are the years of healthy life lost because of disease, named DALYs

  (Disability Adjusted Life Years).

  DALYs result from the sum of years lost by premature mortality over the

  years that are lost through living in disability status.

  The advantages of using a measure of health at the population level as

  lost DALYs is that it allows comparing interventions for different

  diseases and addresses a relevant question from the avoidable burden

  health policy standpoint.

  Interventions evaluated included: 1. tricyclic antidepressants, 2. new

  antidepressants (SSRIs), 3. brief psychotherapy, 4. trycliclic

  antidepressants + brief psychotherapy, 5. new antidepressants + brief

  psychotherapy, 6. tricyclic antidepressants + brief psychotherapy +

  proactive case management, and 7. new antidepressants + brief

  psychotherapy + proactive case management.

  DALYs avoided as a result of each intervention or combination were

  calculated to determine its effectiveness. Both patients and program

  costs, a 3\% discount by the process of converting future values to

  present ones, as well as an age adjustment giving less weight to year

  lived by the young were included. Finally, the cost of averted DALYs for

  each intervention was estimated to determine their cost effectiveness.

  Results

  The combined strategies of proactive case management with psychotherapy

  plus antidepressants can be considered as the most effective one.

  With the combination with tricyclic antidepressants, the number of DALYs

  averted was 207,171, and with SSRI of 217,568, corresponding to more

  than double of DALYs when tricyclic antidepressants are used alone and

  almost double when using only SSRIs.

  The most expensive intervention was the combination of SSRIs with brief

  psychotherapy, with a total of \$12,256 million pesos (972 million

  dollars), the least expensive treatment were tricyclic antidepressants,

  which involved \$4,523 million pesos (359 million dollars).

  Over 99\% of the costs were from patient medications, and less than 1\%

  from program and training costs. It is clear that the greatest cost is

  for added proactive case management.

  The use of SSRI was the most cost-effective treatment (no combination)

  for the management of depression in Mexican primary care.

  The most cost-effective combination was tryciclic antidepressants plus

  brief psychotherapy plus proactive case management.

  Conclusions

  Although the are some studies on health economics in Mexico, most are

  directed to consider costs, and few ones have evaluated the

  cost-effectiveness relationship of diagnostic and therapeutic

  interventions, lees son in the mental health field.

  Antecedents of the present study in Mexico included a study that

  observed that psychiatric patients require more medical consultations,

  laboratory analysis, hospitalization days, surgeries and medication, in

  contrast with patients that never needed mental attention.

  Nevertheless, investigations about cost-effectiveness relationship are

  rare. Just one study evaluates the costs of positive changes in

  psychopathology with antipsychotic medication for the treatment of

  schizophrenic patients. In this direction, the present work is the first

  effort to evaluate cost-effectiveness of different communitarian

  interventions to treat depression in Mexico.

  According with our findings, also in Mexico, the interventions available

  to treat depression in primary care level prevent a substantial number

  of DALYs: almost six times when SSRIs plus brief psychotherapy plus

  proactive case management are administered.

  The specific effect of proactive case management is preventing relapses

  and increasing the time free of disease, which results in greater

  benefit to the patient, his family and the society. Thus, interventions

  are cost-effective despite the proactive case management significantly

  increases the cost of care to these patients.

  In conclusion, the inclusion of psychosocial treatments is advantageous

  from a cost-effectiveness standpoint. Averted DALYs with these

  interventions are more ``economic{''''}.

  As observed in previous studies, a modest investment in improving

  depression produces greater gains in resource-limited environments. In

  Mexico, there is evidence that such interventions in primary care are

  effective when they are given by medical staff with a brief training,

  making them a promising tool for a cost-effective and evidence-based

  public policy.'
affiliation: 'Medina-Mora, ME (Corresponding Author), Inst Nacl Psiquiatria Ramon
  de la Fuente Muniz, Calzada Mexico Xochimilco 101, Mexico City 14370, DF, Mexico.

  del Carmen Lara-Munoz, Maria; Robles-Garcia, Rebeca; Orozco, Ricardo; Real, Tania;
  Elena Medina-Mora, Ma., Inst Nacl Psiquiatria Ramon de la Fuente Muniz, Mexico City
  14370, DF, Mexico.

  del Carmen Lara-Munoz, Maria, B Univ Autonoma Puebla, Fac Med, Puebla, Mexico.'
author: del Carmen Lara-Munoz, Maria and Robles-Garcia, Rebeca and Orozco, Ricardo
  and Real, Tania and Chisholm, Dan and Elena Medina-Mora, Ma.
author-email: medinam@imp.edu.mx
author_list:
- family: del Carmen Lara-Munoz
  given: Maria
- family: Robles-Garcia
  given: Rebeca
- family: Orozco
  given: Ricardo
- family: Real
  given: Tania
- family: Chisholm
  given: Dan
- family: Elena Medina-Mora
  given: Ma.
da: '2023-09-28'
files: []
issn: 0185-3325
journal: SALUD MENTAL
keywords: Depression; treatment; cost-effectiveness
keywords-plus: 'PRIMARY-CARE PATIENTS; LOW-INCOME WOMEN; COLLABORATIVE CARE; MAJOR

  DEPRESSION; GLOBAL BURDEN; DISORDERS; HEALTH; PHARMACOTHERAPY;

  PSYCHOTHERAPY; POPULATION'
language: Spanish
month: JUL-AUG
number: '4'
number-of-cited-references: '43'
orcid-numbers: 'Orozco, Ricardo/0000-0002-6580-585X

  Medina-Mora, María Elena I/0000-0001-9300-0752

  Robles, Rebeca/0000-0001-5958-7393

  '
pages: 301-308
papis_id: 6913c419606ae2cfe0a9ca2e729a198c
ref: Delcarmenlaramunoz2010costeffectivenessstu
researcherid-numbers: 'Orozco, Ricardo/I-3518-2015

  Medina-Mora, María Elena I/T-5937-2018

  Robles, Rebeca/GOV-6128-2022

  Garcia, Rebeca/GRJ-1228-2022'
times-cited: '18'
title: Cost-effectiveness study of depression management in Mexico
type: article
unique-id: WOS:000282247400001
usage-count-last-180-days: '0'
usage-count-since-2013: '32'
volume: '33'
web-of-science-categories: Psychiatry
year: '2010'