RESUMEN
PURPOSE: Depression is a leading cause of disability worldwide. Research suggests that by far, the greatest contributor to the overall economic impact of depression is loss in productivity; however, there is very little research on the costs of depression outside of Western high-income countries. Thus, this study examines the impact of depression on workplace productivity across eight diverse countries. METHODS: We estimated the extent and costs of depression-related absenteeism and presenteeism in the workplace across eight countries: Brazil, Canada, China, Japan, South Korea, Mexico, South Africa, and the USA. We also examined the individual, workplace, and societal factors associated with lower productivity. RESULTS: To the best of our knowledge, this is the first study to examine the impact of depression on workplace productivity across a diverse set of countries, in terms of both culture and GDP. Mean annual per person costs for absenteeism were lowest in South Korea at $181 and highest in Japan ($2674). Mean presenteeism costs per person were highest in the USA ($5524) and Brazil ($5788). Costs associated with presenteeism tended to be 5-10 times higher than those associated with absenteeism. CONCLUSIONS: These findings suggest that the impact of depression in the workplace is considerable across all countries, both in absolute monetary terms and in relation to proportion of country GDP. Overall, depression is an issue deserving much greater attention, regardless of a country's economic development, national income or culture.
Asunto(s)
Absentismo , Depresión/psicología , Trastorno Depresivo/psicología , Eficiencia , Presentismo , Lugar de Trabajo/economía , Adulto , Brasil , Canadá , China , Costos y Análisis de Costo , Depresión/economía , Trastorno Depresivo/economía , Personas con Discapacidad , Femenino , Humanos , Japón , Masculino , México , Persona de Mediana Edad , República de Corea , Sudáfrica , Lugar de Trabajo/psicologíaRESUMEN
BACKGROUND: A high proportion of women consulting for depression have a history of childhood abuse and trauma. AIM: To compare the efficacy and costs associated with a treatment that enquires directly into childhood trauma and understands present interpersonal difficulties as a compulsion to repeat the traumatic past, versus the usual treatment, in women with severe depression and childhood trauma. MATERIAL AND METHODS: Eighty seven women with depression and prior history of early trauma that sought help at the Mental Health Unit of the Hospital de Curicó were studied. Forty four were randomly assigned to the experimental treatment, and 43 to the usual management. Patients were evaluated using the Hamilton Depression Scale, the Outcome Questionnaire (OQ 45.2) and an expenditures sheet at baseline, three and six months. An intention to treat analysis and a simple cost-analysis were performed. RESULTS: Hamilton and OQ 45.2 scores improved in both treatment groups, with significantly better results achieved in the experimental patients. The direct overall costs of experimental and control treatments were CLP 8,628,587 and 9,688,240, respectively. The main contributors to costs in both arms were medications (26.5%), followed by the number of psychiatric consultations (19.2%) in the experimental group and by hospitalizations (25.4%) in the control group. The costs per patient recovered in experimental and control groups were CLP 616,328 and 1,973,649, respectively. CONCLUSIONS: The proposed model resulted more effective for the treatment of this group of women.
Asunto(s)
Atención Ambulatoria/economía , Abuso Sexual Infantil/psicología , Costo de Enfermedad , Trastorno Depresivo , Trastornos por Estrés Postraumático , Niño , Abuso Sexual Infantil/economía , Chile , Trastorno Depresivo/economía , Trastorno Depresivo/terapia , Femenino , Gastos en Salud , Humanos , Programas Nacionales de Salud/economía , Trastornos por Estrés Postraumático/economía , Trastornos por Estrés Postraumático/terapiaRESUMEN
Background: A high proportion of women consulting for depression have a history of childhood abuse and trauma. Aim: To compare the effcacy and costs associated with a treatment that inquires directly into childhood trauma and understands present interpersonal diffculties as a compulsion to repeat the traumatic past, versus the usual treatment, in women with severe depression and childhood trauma. Material and Methods: Eighty seven women with depression and prior history of early trauma that sought help at the Mental Health Unit of the Hospital de Curicó were studied. Forty four were randomly assigned to the experimental treatment, and 43 to the usual management. Patients were evaluated using the Hamilton Depression Scale, the Outcome Questionnaire (OQ 45.2) and an expenditures sheet at baseline, three and six months. An intention to treat analysis and a simple cost-analysis were performed. Results: Hamilton and OQ 45.2 scores improved in both treatment groups, with signifcantly better results achieved in the experimental patients. The direct overall costs of experimental and control treatments were CLP 8,628,587 and 9,688,240, respectively. The main contributors to costs in both arms were medications (26.5 percent), followed by the number of psychiatric consultations (19.2 percent) in the experimental group and by hospitalizations (25.4 percent) in the control group. The costs per patient recovered in experimental and control groups were CLP 616,328 and 1,973,649, respectively. Conclusions: The proposed model resulted more effective for the treatment of this group of women.
Asunto(s)
Niño , Femenino , Humanos , Atención Ambulatoria/economía , Abuso Sexual Infantil/psicología , Costo de Enfermedad , Trastorno Depresivo , Trastornos por Estrés Postraumático , Abuso Sexual Infantil/economía , Chile , Trastorno Depresivo/economía , Trastorno Depresivo/terapia , Gastos en Salud , Programas Nacionales de Salud/economía , Trastornos por Estrés Postraumático/economía , Trastornos por Estrés Postraumático/terapiaRESUMEN
BACKGROUND: The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide. AIMS: To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America. METHOD: A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM-IV and ICD-10 criteria, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm and EURO-D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD-10 depression. RESULTS: For DSM-IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD-10 depressive episode between 4.5% and 5.1%, for GMS-AGECAT depression between 30.0% and 35.9% and for EURO-D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD-10 and DSM-IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD-10 depressive episode. CONCLUSIONS: The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.
Asunto(s)
Trastorno Depresivo/epidemiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/economía , Femenino , Estado de Salud , Humanos , Clasificación Internacional de Enfermedades , Masculino , México/epidemiología , Perú/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Salud Rural , Factores Socioeconómicos , Salud Urbana , Venezuela/epidemiologíaRESUMEN
BACKGROUND: Data from the Ministry of Health show that in Chile in 2004, 17% of the population had some form of depression, and mood disorders are the tenth cause of disability-adjusted life years (DALY) loss. AIM: To determine consumption of antidepressants (ADs) in Chile from 1992 to 2004. MATERIAL AND METHODS: National sales data were obtained from the company IMS Health Chile and converted into defined daily doses (DDDs) per 1,000 inhabitants per day. Available ADs were classified in four pharmacological groups (i.e., serotonin-norepinephrine reuptake inhibitors, SNRLs; selective-serotonin reuptake inhibitors, SSRLs; tricyclic antidepressants, TCAs; and others). Total economic burden of ADs utilization and cost per DDDs were also calculated. Trends over time were analyzed using Pearson-R2. RESULTS: Total ADs consumption in Chile measured by DDDs per 1,000 inhabitants per day (DHD) increased linearly (y =0.901x + 1.9129; R2 =0.9296; p <0.001) from 2.5 in 1992 to 11.7 in 2004 (total growth of 470.2%). SSRLs were the drug class with higher consumption, and fluoxetine the most commonly consumed antidepressant. SSRLs were the drugs that dominated the market representing 79% of the total drug consumption throughout the years. Total economic burden of ADs in Chile (total cost of DDDs consumed) increased from US$65.4 million in 2001 to US$74.6 million in 2004 (14% increase). Average cost per DDD of all AD increased linearly, however not significantly from US$ 0.94 in 2001 to US$ 1.04 in 2004 (y =0.0362x + 0.8784; R2 =0.7382; p =0,262). CONCLUSIONS: DDDs per 1,000 inhabitants per day increased linearly over 470% from 1992-2004. SSRLs were the most commonly consumed drugs in Chile. Future research should evaluate the cost-effectiveness of antidepressants in Chile, comparing the results with drug utilization, and determining if unnecessary expenditures have been paid out.
Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Antidepresivos/economía , Chile , Trastorno Depresivo/economía , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Fluoxetina/administración & dosificación , Fluoxetina/economía , Humanos , Masculino , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Inhibidores Selectivos de la Recaptación de Serotonina/economía , Factores de TiempoRESUMEN
OBJECTIVE: To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. METHODS: Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitriptyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of depression (a score <7 on the Hamilton Depression [HAM-D] scale or <12 on the Montgomery-Åsberg Depression Rating Scale [MADRS]) after 8 weeks of treatment. Clinical data were obtained from the literature and costs from standard Colombian price lists. One-way and multivariate sensitivity analyses tested model robustness. RESULTS: Costs per patient (in 2007 US$) for treatment were: venlafaxine, $1 618; fluoxetine, $1 207; and amitriptyline, $1 068. Overall remission rates were 73.1 percent, 64.1 percent, and 71.3 percent, respectively. Amitriptyline dominated fluoxetine (i.e., it had lower costs and higher outcomes). The incremental cost-effectiveness ratio (ICER) of venlafaxine over amitriptyline was US$ 31 595. The acquisition price of venlafaxine was the model's cost driver, comprising 53.4 percent of the total cost/patient treated, compared with 18.5 percent and 24.8 percent for fluoxetine and amitriptyline, respectively. For the others, hospitalization comprised the major cost (72.1 percent and 65.2 percent, respectively). Probabilistic (Monte Carlo) sensitivity analysis confirmed the original findings of the pharmacoeconomic model. CONCLUSIONS: Amitriptyline is cost-effective in comparison to fluoxetine and venlafaxine in Colombia. However, the cost of venlafaxine was estimated for the brand-name product, as generics were not currently available. These cost-effectiveness results can be substantially affected by the presence of generics or drug cost regulations.
OBJETIVO: Comparar tres medicamentos antidepresivos de diferentes clases empleados para tratar trastornos depresivos mayores moderados e intensos en adultos colombianos. MÉTODOS: A partir de los aportes de expertos se adaptó un modelo de árbol de decisión para Colombia a fin de analizar los datos de seis meses desde la perspectiva del gobierno como pagador de los servicios. Se determinó la relación costo-efectividad de la amitriptilina, la fluoxetina y la venlafaxina. El desenlace clínico fue la remisión de la depresión (una puntuación <7 en la escala de depresión de Hamilton o <12 en la escala de valoración de la depresión de Montgomery-Åsberg) después de 8 semanas de tratamiento. Los datos clínicos se obtuvieron de la literatura especializada y los costos, de las listas habituales de precios de Colombia. Se realizaron análisis de sensibilidad simples y multifactoriales para probar la robustez de los modelos. RESULTADOS: Los costos del tratamiento por paciente (en dólares estadounidenses de 2007) fueron: US$ 1 618 para la venlafaxina, US$ 1 207 para la fluoxetina y US$ 1 068 para la amitriptilina. Las tasas de remisión general fueron 73,1 por ciento, 64,1 por ciento y 71,3 por ciento, respectivamente. La amitriptilina tuvo un menor costo y una mayor remisión que la fluoxetina. La razón de rentabilidad incremental de la venlafaxina sobre la amitriptilina fue de US$ 31 595. El inductor de costos (cost driver) del modelo fue el valor de adquisición de la venlafaxina, que representó 53,4 por ciento del total del costo por paciente tratado, en comparación con la fluoxetina (18,5 por ciento) y la amitriptilina (24,8 por ciento). En los otros casos, la hospitalización representó el mayor costo (72,1 por ciento y 65,2 por ciento, respectivamente). El análisis de sensibilidad probabilístico (Monte Carlo) confirmó los resultados preliminares del modelo farmacoeconómico. CONCLUSIONES: En Colombia, la amitriptilina es más efectiva en función del costo que la fluoxetina y la venlafaxina. No obstante, el costo de la venlafaxina se estimó a partir del medicamento de marca, ya que no había genéricos disponibles. Esta relación costo-efectividad puede variar considerablemente con la aparición de medicamentos genéricos o medidas regulatorias del costo de los medicamentos.
Asunto(s)
Humanos , Masculino , Femenino , Amitriptilina/economía , Antidepresivos/economía , Ciclohexanoles/economía , Trastorno Depresivo/tratamiento farmacológico , Fluoxetina/economía , Modelos Teóricos , Amitriptilina/uso terapéutico , Antidepresivos/uso terapéutico , Colombia/epidemiología , Terapia Convulsiva/economía , Análisis Costo-Beneficio , Ciclohexanoles/uso terapéutico , Árboles de Decisión , Trastorno Depresivo/economía , Trastorno Depresivo/epidemiología , Trastorno Depresivo/terapia , Países en Desarrollo , Costos de los Medicamentos , Fluoxetina/uso terapéutico , Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Método de Montecarlo , Programas Nacionales de Salud/economía , Visita a Consultorio Médico/economía , Psicoterapia/economíaRESUMEN
Background: Data from the Ministry of Health show that in Chile in 2004, 17 percent of the population had some form of depression and mood disorders are the tenth cause of disability-adjusted Ufe years (DALY) loss. Aim: To determine consumption of antidepressants (ADs) in Chile from 1992 to 2004. Material and methods: National sales data were obtained from the company IMS Health Chile and converted into defined daily doses (DDDs) per 1,000 inhabitants per day Available ADs were classified in four pharmacological groups (i.e., serotonin-norepinephrine reuptake inhibitors, SNRIs; selective-serotonin reuptake inhibitors, SSRIs; tricyclic antidepressants, TCAs; and others). Total economic burden of ADs utilization and cost per DDDs were also calculated. Trends over time were analyzed using Pearson-R2. Results: Total ADs consumption in Chile measured by DDDs per 1,000 inhabitants per day (DHD) increased linearly (y =0.901x+1.9129; R2 =0.9296; p <0.001) from 2.5 in 1992 to 11.7 in 2004 (total growth of 470.2 percent). SSRIs were the drug class with higher consumption, and fluoxetine the most commonly consumed antidepressant. SSRIs were the drugs that dominated the market representing 79 percent of the total drug consumption throughout the years. Total economic burden of ADs in Chile (total cost of DDDs consumed) increased from US$65.4 million in 2001 to US$74.6 million in 2004 (14 percent increase). Average cost per DDD of all AD increased linearly, however not significantly from US$ 0.94 in 2001 to US$ 1.04 in 2004 (y =0.0362x+0.8784; R2 =0.7382; p =0,262). Conclusions: DDDs per 1,000 inhabitants per day increased linearly over 470 percent from 1992-2004. SSRIs were the most commonly consumed drugs in Chile. Future research should evaluate the cost-effectiveness of antidepressants in Chile, comparing the results with drug utilization, and determining if unnecessary expenditures have been paid out.
Asunto(s)
Femenino , Humanos , Masculino , Antidepresivos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Antidepresivos/economía , Chile , Trastorno Depresivo/economía , Costos de los Medicamentos/estadística & datos numéricos , Fluoxetina/administración & dosificación , Fluoxetina/economía , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Inhibidores Selectivos de la Recaptación de Serotonina/economía , Factores de TiempoRESUMEN
OBJECTIVE: To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. METHODS: Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitriptyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of depression (a score Asunto(s)
Amitriptilina/economía
, Antidepresivos/economía
, Ciclohexanoles/economía
, Trastorno Depresivo/tratamiento farmacológico
, Fluoxetina/economía
, Modelos Teóricos
, Amitriptilina/uso terapéutico
, Antidepresivos/uso terapéutico
, Colombia/epidemiología
, Terapia Convulsiva/economía
, Análisis Costo-Beneficio
, Ciclohexanoles/uso terapéutico
, Árboles de Decisión
, Trastorno Depresivo/economía
, Trastorno Depresivo/epidemiología
, Trastorno Depresivo/terapia
, Países en Desarrollo
, Costos de los Medicamentos
, Femenino
, Fluoxetina/uso terapéutico
, Gastos en Salud/estadística & datos numéricos
, Hospitalización/economía
, Hospitalización/estadística & datos numéricos
, Humanos
, Masculino
, Método de Montecarlo
, Programas Nacionales de Salud/economía
, Visita a Consultorio Médico/economía
, Psicoterapia/economía
, Clorhidrato de Venlafaxina
RESUMEN
OBJECTIVE: To determine the cost effectiveness, from the Brazilian Ministry of Health viewpoint, of three antidepressant classes for major depressive disorder (MDD), and the budget impact of introducing serotonin-noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) into the current Brazilian national drug formulary, assuming a 6-month treatment duration. METHODS: An existing decision-tree model was adapted to Brazil, based on local guidelines. Clinical data were obtained from published meta-analyses. Patients included adults aged > or =18 years with MDD, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, third and fourth editions (DSM-III/IV), with moderate-to-severe disease (Hamilton Depression Rating Scale [HAMD] > or =15 or Montgomery-Asberg Depression Rating Scale [MADRS] > or =18), without co-morbidities or co-medications, receiving > or =6 weeks of treatment with SNRIs, selective serotonin reuptake inhibitors (SSRIs) and/or tricyclic antidepressants (TCAs). Clinical outcome was remission (HAMD < or =7 or MADRS < or =12). Direct costs (drugs, physician visits, hospitalisations) were included. Drug costs were obtained from the 2006 Brazilian National Drug Price List, and hospitalisation and physician costs from the 2006 Healthcare System database. Costs were valued in Brazilian Reais ($Brz), year 2006 values ($Brz1 = $US0.47). Univariate and Monte Carlo sensitivity analyses tested model robustness. RESULTS: Expected costs per patient treated were SNRIs $Brz4848; SSRIs $Brz5466; and TCAs $Brz5046, and overall success rates (primary plus secondary treatment across all decision tree branches) were SNRIs 78.1%; SSRIs 74.0%; and TCAs 76.4%. Average costs/success were SNRIs $Brz6209; SSRIs $Brz7385; and TCAs $Brz6602. SNRIs dominated in incremental cost-effectiveness analyses. Monte Carlo analysis confirmed drug classes' relative positions; however, there was considerable uncertainty. Introducing SNRIs into the formulary could generate average savings of 1% of the total budget, with a 52% probability of savings. CONCLUSIONS: SNRIs appear to be cost effective against SSRIs and TCAs when prescribed to patients with MDD in Brazil. However, their inclusion into the national drug list would generate minor savings compared with the current formulary of SSRIs and TCAs. Thus, we considered such inclusion as 'cost-neutral', since no major probability of savings or increased expenditures were observed.
Asunto(s)
Inhibidores de Captación Adrenérgica/economía , Inhibidores de Captación Adrenérgica/uso terapéutico , Trastorno Depresivo/economía , Trastorno Depresivo/epidemiología , Inhibidores Selectivos de la Recaptación de Serotonina/economía , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Brasil/epidemiología , Presupuestos , Análisis Costo-Beneficio , Trastorno Depresivo/tratamiento farmacológico , Formularios Farmacéuticos como Asunto , Humanos , Escalas de Valoración PsiquiátricaRESUMEN
A depressäo é uma doença grave e comum, associada com prejuízo do funcionamento social e ocupacional, e com alto custo econômico. Pesquisas e observaçöes clínicas têm demonstrado que pacientes com depressäo têm uma significativa probabilidade de apresentar recaída, recorrência, cronicidade e sintomas subsindrômicos residuais entre os episódios da doença. Apesar de sua gravidade, observou-se que muitos pacientes näo säo adequadamente diagnosticados e tratados na populaçäo geral. Até o momento, pouco se sabe sobre a patogênesee a fisiopatologia da depressäo. Assim como, nenhum marcador biológico apresenta sensibilidade, especificidade e valor preditivo para auxiliar o diagnóstico dos transtornos depressivos, prever sua evoluçäo, orientar a terapêutica e promover a seleçäo de pacientes. Existem questöes ainda näo resolvidas no tratamento da depressäo unipolar recorrente. A primeira diz respeito à duraçäo do tratamento. Atualmente, há uma tendência em se manter a dose de antidepressor usada na fase aguda. Aproximadamente, 20 a 30 por cento dos pacientes com transtorno depressivo maior näo têm uma resposta satisfatória ao tratamento com antidepressores. Esta "näo resposta" ao tratamento pode resultar de um erro diagnóstico, do tratamento inadequado, da coexistência de outras condiçöes médicas e psiquiátricas e/ou de fatores psicosociais complicadores
Asunto(s)
Humanos , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/economía , Trastorno Depresivo/fisiopatología , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/diagnóstico , Dopamina/uso terapéutico , Electrofisiología , Trastornos del Humor/psicología , Neurobiología , Neuroendocrinología , Calidad de Vida , Suicidio , Hormona Liberadora de TirotropinaRESUMEN
Se lleva a cabo una revisión bibliográfica acerca del impacto socioeconómico de los trastornos depresivos. Santiago de Chile tiene tasas de prevalencia semestrales de trastornos psiquiátricos más altas que otras ciudades del mundo, siendo los trastornos afectivos los más frecuentes. Estudios internacionales indican que las personas que sufren de trastornos depresivos experimentan un cúmulo de limitaciones funcionales, físicas y psicosociales, y altas tasas de días de reposo. Esto tiene un impacto considerable en el bienestar personal, en las relaciones interpersonales y en la productividad laboral debido a la alta prevalencia de estos trastornos. Las estimaciones del Banco Mundial sobre discapacidad y años de vida saludable perdidos por trastornos depresivos figuran entre las más altas, sólo superadas por la carga de morbilidad atribuible a las enfermedades cardiovasculares. En Chile, la Depresión Mayor constituye la segunda causa de pérdida de años de vida ajustado por discapacidad en las mujeres de edad adulta. A pesar que se han producido enormes avances en los últimos años en el tratamiento de las enfermedades mentales y que la depresión tiene una respuesta muy buena a éste, un porcentaje importante de los afectados por ella nunca recibe tratamiento y, por ende, mantiene la sintomatología y la discapacidad,con lo cual se genera un alto costo económico a la sociedad