Health economics of depression

Health economics deals with how resources are used for health production and how they should be most efficiently allocated to maximise health outcomes. Many treatment alternatives for depression are currently available, but there is insufficient knowledge of their consequences on costs and their value of actual and potential health gains. The aims of the present thesis were to study aspects of the health economics of depression that are important for priority settings: the burden of depression to society, cost and health-related quality of life associated with patients treated for depression and modelling the cost-effectiveness of treatments for depression. A new approach was developed to assess the societal cost of depression in Europe. The results showed that more than 21 million Europeans are suffering from depression and that depression cost European society more than SEK 1000 billion per year, two-thirds of which are found outside the healthcare system. The cost of depression equals SEK 2 300 per inhabitant in Europe corresponding to 1% of the European national incomes. Naturalistic studies of cost and outcome in clinical practice are rare. The study "Health Economics of Depression In Sweden" (HEADIS) is one of the first naturalistic observational studies conducted in Sweden, collecting information on the cost and quality of life related to patients treated for depression in primary care. The cost for a patient treated for a depressive episode was estimated at SEK 51000. Depressed patients were, on average, absent from work 1.5 months during six months, which constituted 65% of the total costs for depression. Depression causes a reduction in quality of life of 50% as compared to the general population, which is in the same range as after a severe stroke. Treatment significantly improved patients' quality of life measured with a standard generic quality of life instrument (EQ-5D). For patients who went into remission, we observed both statistically significant reductions in costs and improvements in quality of life of more than 40% as compared to non-remitting patients. A computer simulation model was developed to project costs and benefits from alternative treatments for depression. The health economic data collected in the HEADIS study was used in the model. A simulation was performed with a hypothetical intervention over a five-year period. The results showed that a new treatment which increases the probability that the patient goes into remission, produced cost savings amounting to SEK 20 100 and a QALY gain of 0.07. The results underscore that the achievement of clinical remission is a key health economic parameter to reduce the burden of depression. This thesis has contributed with new health economic data on the social cost of depression at an international level, and patient-level data of costs and quality of life for depressed patients in a primary care setting. Accurately estimating the impact of a disease, in terms of costs and quality of life, is the first important step towards better priorities of resource allocation to reduce the burden of the disease. This data is also an input in economic evaluations, which provides information for allocation of resources between different types of treatments. Increased research efforts are needed to provide the necessary effectiveness data in clinical practice, and to make such studies relevant and credible as instruments for resource allocation in practice