Loading...
Please wait, while we are loading the content...
Similar Documents
Estudio de costo efectividad del tratamiento de la depresión en México
| Content Provider | Semantic Scholar |
|---|---|
| Author | Lara-Muñoz, María Del Carmen Robles-Garcia, Rebeca Orozco, Ricardo Real, Tania Chisholm, Dan Medina-Mora, María Elena |
| Copyright Year | 2010 |
| Abstract | SUMMARYIntroductionDepression is a public health problem that carries substantial costsfor the individual and the society. In order to establish evidence-basedpriorities for resource allocation in mental health care, it is necessaryto integrate the costs and effectiveness of interventions and specifythe essential packages for their treatment.The following are pioneering studies of cost-effectiveness forthe treatment of depression: 1. compared psychopharmacologyoptions (fluoxetine, imipramine and desipramine) to found nodifference between drugs in terms of clinical efficacy, effect on qualityof life and costs, and 2. evaluated cost-effectiveness of collaborativeprogram of stepped care in primary care of persistent depression,to demonstrate a substantial increase in the effectiveness andadditional moderate cost increase in comparison with usualtreatment.Recently, the World Health Organization convened the NationalInstitute of Psychiatry Ramon de la Fuente, as a collaborating center, toparticipate in the «Selecting interventions that are cost-effective» labeledWHO-CHOICE (CHOosing Interventions that are Cost-Effective ).This paper presents the findings of the evaluation of cost-effectiveness of different clinical interventions for the treatment ofdepression in Mexico, considering its implementation in primary careservices.MethodThe cost-effectiveness unit of measure gathered by WHO (and usedin 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 mortalityover the years that are lost through living in disability status.The advantages of using a measure of health at the populationlevel as lost DALYs is that it allows comparing interventions for differentdiseases and addresses a relevant question from the avoidable burdenhealth policy standpoint.Interventions evaluated included: 1. tricyclic antidepressants, 2.new antidepressants (SSRIs), 3. brief psychotherapy, 4. trycliclic antide-pressants + brief psychotherapy, 5. new antidepressants + brief psycho-therapy, 6. tricyclic antidepressants + brief psychotherapy + proactivecase management, and 7. new antidepressants + brief psychotherapy+ proactive case management.DALYs avoided as a result of each intervention or combinationwere calculated to determine its effectiveness. Both patients andprogram costs, a 3% discount by the process of converting future valuesto present ones, as well as an age adjustment giving less weight toyear lived by the young were included. Finally, the cost of averted DALYsfor each intervention was estimated to determine their cost effectiveness.ResultsThe combined strategies of proactive case management withpsychotherapy plus antidepressants can be considered as the mosteffective one.With the combination with tricyclic antidepressants, the numberof DALYs averted was 207,171, and with SSRI of 217,568,corresponding to more than double of DALYs when tricyclic anti-depressants are used alone and almost double when using only SSRIs.The most expensive intervention was the combination of SSRIswith brief psychotherapy, with a total of $12,256 million pesos (972million dollars), the least expensive treatment were tricyclicantidepressants, which involved $4,523 million pesos (359 milliondollars).Over 99% of the costs were from patient medications, and lessthan 1% from program and training costs. It is clear that the greatestcost is for added proactive case management.The use of SSRI was the most cost-effective treatment (nocombination) for the management of depression in Mexican primarycare.The most cost-effective combination was tryciclic antidepressantsplus brief psychotherapy plus proactive case management.ConclusionsAlthough the are some studies on health economics in Mexico, mostare directed to consider costs, and few ones have evaluated the cost-effectiveness relationship of diagnostic and therapeutic interventions,lees son in the mental health field.Antecedents of the present study in Mexico included a study thatobserved that psychiatric patients require more medical consultations,laboratory analysis, hospitalization days, surgeries and medication,in contrast with patients that never needed mental attention. |
| Starting Page | 301 |
| Ending Page | 308 |
| Page Count | 8 |
| File Format | PDF HTM / HTML |
| Volume Number | 33 |
| Alternate Webpage(s) | http://www.inprf-cd.gob.mx/pdf/sm3304/sm3304301.pdf |
| Alternate Webpage(s) | http://www.scielo.org.mx/pdf/sm/v33n4/v33n4a1.pdf |
| Alternate Webpage(s) | http://www.medigraphic.com/pdfs/salmen/sam-2010/sam104a.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
