254 lines
7.8 KiB
YAML
254 lines
7.8 KiB
YAML
abstract: 'Introduction
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Depression is a public health problem that carries substantial costs for
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the individual and the society. In order to establish evidence-based
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priorities for resource allocation in mental health care, it is
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necessary to integrate the costs and effectiveness of interventions and
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specify the essential packages for their treatment.
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The following are pioneering studies of cost-effectiveness for the
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treatment of depression: 1. compared psychopharmacology options
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(fluoxetine, imipramine and desipramine) to found no difference between
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drugs in terms of clinical efficacy, effect on quality of life and
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costs, and 2. evaluated cost-effectiveness of collaborative program of
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stepped care in primary care of persistent depression, to demonstrate a
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substantial increase in the effectiveness and additional moderate cost
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increase in comparison with usual treatment.
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Recently, the World Health Organization convened the National Institute
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of Psychiatry Ramon de la Fuente, as a collaborating center, to
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participate in the ``Selecting interventions that are
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cost-effective{''''}. labeled WHO-CHOICE (CHOosing Interventions that are
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Cost-Effective).
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This paper presents the findings of the evaluation of cost-effectiveness
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of different clinical interventions for the treatment of depression in
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Mexico, considering its implementation in primary care services.
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Method
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The cost-effectiveness unit of measure gathered by WHO (and used in this
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work) are the years of healthy life lost because of disease, named DALYs
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(Disability Adjusted Life Years).
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DALYs result from the sum of years lost by premature mortality over the
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years that are lost through living in disability status.
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The advantages of using a measure of health at the population level as
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lost DALYs is that it allows comparing interventions for different
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diseases and addresses a relevant question from the avoidable burden
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health policy standpoint.
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Interventions evaluated included: 1. tricyclic antidepressants, 2. new
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antidepressants (SSRIs), 3. brief psychotherapy, 4. trycliclic
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antidepressants + brief psychotherapy, 5. new antidepressants + brief
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psychotherapy, 6. tricyclic antidepressants + brief psychotherapy +
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proactive case management, and 7. new antidepressants + brief
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psychotherapy + proactive case management.
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DALYs avoided as a result of each intervention or combination were
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calculated to determine its effectiveness. Both patients and program
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costs, a 3\% discount by the process of converting future values to
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present ones, as well as an age adjustment giving less weight to year
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lived by the young were included. Finally, the cost of averted DALYs for
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each intervention was estimated to determine their cost effectiveness.
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Results
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The combined strategies of proactive case management with psychotherapy
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plus antidepressants can be considered as the most effective one.
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With the combination with tricyclic antidepressants, the number of DALYs
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averted was 207,171, and with SSRI of 217,568, corresponding to more
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than double of DALYs when tricyclic antidepressants are used alone and
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almost double when using only SSRIs.
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The most expensive intervention was the combination of SSRIs with brief
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psychotherapy, with a total of \$12,256 million pesos (972 million
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dollars), the least expensive treatment were tricyclic antidepressants,
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which involved \$4,523 million pesos (359 million dollars).
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Over 99\% of the costs were from patient medications, and less than 1\%
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from program and training costs. It is clear that the greatest cost is
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for added proactive case management.
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The use of SSRI was the most cost-effective treatment (no combination)
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for the management of depression in Mexican primary care.
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The most cost-effective combination was tryciclic antidepressants plus
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brief psychotherapy plus proactive case management.
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Conclusions
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Although the are some studies on health economics in Mexico, most are
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directed to consider costs, and few ones have evaluated the
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cost-effectiveness relationship of diagnostic and therapeutic
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interventions, lees son in the mental health field.
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Antecedents of the present study in Mexico included a study that
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observed that psychiatric patients require more medical consultations,
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laboratory analysis, hospitalization days, surgeries and medication, in
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contrast with patients that never needed mental attention.
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Nevertheless, investigations about cost-effectiveness relationship are
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rare. Just one study evaluates the costs of positive changes in
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psychopathology with antipsychotic medication for the treatment of
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schizophrenic patients. In this direction, the present work is the first
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effort to evaluate cost-effectiveness of different communitarian
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interventions to treat depression in Mexico.
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According with our findings, also in Mexico, the interventions available
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to treat depression in primary care level prevent a substantial number
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of DALYs: almost six times when SSRIs plus brief psychotherapy plus
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proactive case management are administered.
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The specific effect of proactive case management is preventing relapses
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and increasing the time free of disease, which results in greater
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benefit to the patient, his family and the society. Thus, interventions
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are cost-effective despite the proactive case management significantly
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increases the cost of care to these patients.
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In conclusion, the inclusion of psychosocial treatments is advantageous
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from a cost-effectiveness standpoint. Averted DALYs with these
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interventions are more ``economic{''''}.
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As observed in previous studies, a modest investment in improving
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depression produces greater gains in resource-limited environments. In
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Mexico, there is evidence that such interventions in primary care are
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effective when they are given by medical staff with a brief training,
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making them a promising tool for a cost-effective and evidence-based
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public policy.'
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affiliation: 'Medina-Mora, ME (Corresponding Author), Inst Nacl Psiquiatria Ramon
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de la Fuente Muniz, Calzada Mexico Xochimilco 101, Mexico City 14370, DF, Mexico.
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del Carmen Lara-Munoz, Maria; Robles-Garcia, Rebeca; Orozco, Ricardo; Real, Tania;
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Elena Medina-Mora, Ma., Inst Nacl Psiquiatria Ramon de la Fuente Muniz, Mexico City
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14370, DF, Mexico.
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del Carmen Lara-Munoz, Maria, B Univ Autonoma Puebla, Fac Med, Puebla, Mexico.'
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author: del Carmen Lara-Munoz, Maria and Robles-Garcia, Rebeca and Orozco, Ricardo
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and Real, Tania and Chisholm, Dan and Elena Medina-Mora, Ma.
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author-email: medinam@imp.edu.mx
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author_list:
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- family: del Carmen Lara-Munoz
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given: Maria
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- family: Robles-Garcia
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given: Rebeca
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- family: Orozco
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given: Ricardo
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- family: Real
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given: Tania
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- family: Chisholm
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given: Dan
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- family: Elena Medina-Mora
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given: Ma.
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da: '2023-09-28'
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files: []
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issn: 0185-3325
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journal: SALUD MENTAL
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keywords: Depression; treatment; cost-effectiveness
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keywords-plus: 'PRIMARY-CARE PATIENTS; LOW-INCOME WOMEN; COLLABORATIVE CARE; MAJOR
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DEPRESSION; GLOBAL BURDEN; DISORDERS; HEALTH; PHARMACOTHERAPY;
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PSYCHOTHERAPY; POPULATION'
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language: Spanish
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month: JUL-AUG
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number: '4'
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number-of-cited-references: '43'
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orcid-numbers: 'Orozco, Ricardo/0000-0002-6580-585X
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Medina-Mora, María Elena I/0000-0001-9300-0752
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Robles, Rebeca/0000-0001-5958-7393
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'
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pages: 301-308
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papis_id: 6913c419606ae2cfe0a9ca2e729a198c
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ref: Delcarmenlaramunoz2010costeffectivenessstu
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researcherid-numbers: 'Orozco, Ricardo/I-3518-2015
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Medina-Mora, María Elena I/T-5937-2018
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Robles, Rebeca/GOV-6128-2022
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Garcia, Rebeca/GRJ-1228-2022'
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times-cited: '18'
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title: Cost-effectiveness study of depression management in Mexico
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type: article
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unique-id: WOS:000282247400001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '32'
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volume: '33'
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web-of-science-categories: Psychiatry
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year: '2010'
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