Using epidemiological data to model efficiency in reducing the burden of depression

Abstract

BACKGROUND: The Global Burden of Disease study has suggested that mental disorders are the leading cause of disability burden in the world. This study takes the leading cause of mental disorder burden, depression, and trials an approach for defining the present and optimal efficiency of treatment in an Australian setting. AIMS OF THE STUDY: To examine epidemiological and service use data for depression to trial an approach for modelling (i) the burden that is currently averted from current care, (ii) the burden that is potentially avertable from a hypothetical regime of optimal care, (iii) the efficiency or cost-effectiveness of both current and optimal services for depression and (iv) the potential of current knowledge for reducing burden due to depression, by applying the WHO five-step method for priorities for investment in health research and development. METHODS: Effectiveness and efficiency were calculated in disability adjusted life years (DALYs) averted by adjusting the disability weight for people who received efficacious treatment. Data on service use and treatment outcome were obtained from a variety of secondary sources, including the Australian National Survey of Mental Health and Wellbeing, and efficacy of individual treatments from published meta-analyses expressed in effect sizes. Direct costs were estimated from published sources. RESULTS: Fifty-five percent of people with depression had had some contact with either primary care or specialist services. Effective coverage of depression was low, with only 32% of cases receiving efficacious treatment that could have lessened their severity (averted disability). In contrast, a proposed model of optimal care for the population management of depression provided increased treatment contacts and a better outcome. In terms of efficiency, optimal care dominated current care, with more health gain for less expenditure (28 632 DALYs were averted at a cost of AUD295 million with optimal care, versus 19 297 DALYs averted at a cost of AUD720 million with current care). However, despite the existence of efficacious technologies for treating depression, only 13% of the burden was averted from present active treatment, primarily because of the low effective coverage. Potentially avertable burden is nearly three times this, if effective treatments can be delivered in appropriate amounts to all those who need it. DISCUSSION: This paper reports a method to calculate the burden currently averted from cross-sectional survey data, and to calculate the burden likely to be averted from an optimal programme estimated from randomized controlled trial data. The approach taken here makes a number of assumptions: that people are accurate in reporting their service use, that effect sizes are a suitable basis for modelling improvements in disability and that the method used to translate effect sizes to disability weight change is valid. The robustness of these assumptions is discussed. Nonetheless it would appear that while optimal care could do more than present services to red...

Opportunities for Cost-Effective Prevention of Late-Life Depression: An Epidemiological Approach

“…[14][15][16] However, according to a recent estimate, the total disease burden associated with depression can only be reduced about 50%, even under a hypothetical regime of optimal evidence-based treatment. 17 This is another reason why prevention has to play an important role in public health. Recently, a meta-analysis of randomized trials of preventive interventions has shown that the incidence of depressive disorder can be reduced by 30%, and this may indicate that prevention is a viable option.…”

“…41 We are currently conducting such a study. It is recommended that in the future, the methodology presented in this article or related methodologies 17,42 should be further developed and employed to direct both research and prevention where they are likely to be most cost-effective. which is financed by the Netherlands Ministry of Welfare, Health, and Sports, the Hague.…”

The role of technology in Australian youth mental health reform

“…1 Only 30% of females and 20% of males seek professional help [2][3][4][5][6] and, even when young people access services, they do not always receive timely, evidencebased care. 7,8 The increased uptake of new and emerging technologies in recent years provides an unprecedented opportunity to engage young people, with the Australian Bureau of Statistics (ABS) reporting that 97% of those aged 15-17 years and 96% of those aged 18-24 years accessed the Internet during 2012-13. 9 Herein we consider the ways that young people use the Internet and explore how it may be used to provide services that have the potential to optimise the general health and wellbeing (including mental health) of young people.…”

An Epidemiological Approach to Depression Prevention in Old Age

“…As a result, the maximum health gain attributable to treatment has been estimated to be around 30%. 10,11 Another important issue is the enormous annual influx of new cases of depression: one in every five cases of clinically relevant late-life depression is, in fact, a new or recurrent case. 12 For these reasons it is crucial not to solely rely on treatment, but also to attempt to reduce the number of new cases.…”