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

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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
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000282247400001
usage-count-last-180-days: '0'
usage-count-since-2013: '32'
volume: '33'
web-of-science-categories: Psychiatry
year: '2010'