Cost-effectiveness study of the treatment of depression in Mexico [Estudio de costo-efectividad del tratamiento de la depresión en México]
Por:
del Carmen Lara-Muñoz M., Robles-García R., Orozco R., Real T., Chisholm D., Medina-Mora M.E.
Publicada:
1 ene 2010
Resumen:
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 Ramón 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 costeffectiveness 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
Filiaciones:
del Carmen Lara-Muñoz M.:
Facultad de Medicina, B Universidad Autónoma de Puebla, Mexico
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
Robles-García R.:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
Orozco R.:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
Real T.:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
Chisholm D.:
Organización Mundial de la Salud, Mexico
Medina-Mora M.E.:
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico
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