What is the economic burden of depression on healthcare systems and how can it be managed?

From the Guidelines

Depression imposes a substantial economic burden on healthcare systems, with an estimated cost of $326.2 billion in 2018, and this burden continues to grow each year. To manage this burden, healthcare systems should implement integrated care models that combine mental health services with primary care, allowing for earlier detection and treatment 1. The most recent and highest quality study recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1.

Key Recommendations

• Implement integrated care models that combine mental health services with primary care
• Use evidence-based treatments including selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy
• Utilize digital mental health interventions, such as online therapy platforms and mobile applications for symptom monitoring
• Implement workplace mental health programs that include employee assistance programs and stress management training
• Use prevention strategies targeting high-risk populations through screening programs using tools like the PHQ-9 questionnaire

Rationale

The economic burden of depression is significant, and it is essential to manage this burden by implementing cost-effective treatments and interventions. The use of integrated care models, evidence-based treatments, and digital mental health interventions can help reduce hospitalization rates, emergency department visits, and long-term treatment costs. Workplace mental health programs and prevention strategies can also help minimize productivity losses and absenteeism.

Evidence-Based Treatments

• Selective serotonin reuptake inhibitors (SSRIs) like sertraline (50-200mg daily) or escitalopram (10-20mg daily) for 6-12 months
• Cognitive behavioral therapy (typically 12-16 weekly sessions)
• Digital mental health interventions, such as online therapy platforms and mobile applications for symptom monitoring

Prevention Strategies

• Screening programs using tools like the PHQ-9 questionnaire to identify depression early
• Workplace mental health programs that include employee assistance programs and stress management training
• Targeting high-risk populations through prevention strategies to reduce long-term treatment costs.

From the Research

Economic Burden of Depression

The economic burden of depression on healthcare systems is substantial, with various studies indicating significant costs associated with the condition. Some of the key findings include:

• Depression leads to higher healthcare utilization and spending, with a significant portion of these costs not directly related to depression treatment 2.
• The economic burden of depression is estimated to be in the tens of billions of dollars each year in the US alone, with the largest component being lost work productivity due to depression 3.
• Treatment-resistant depression (TRD) is associated with a high economic burden, with significantly higher healthcare resource utilization and costs compared to non-TRD patients 4, 5.

Cost-Effectiveness of Treatment

While the economic burden of depression is significant, various studies have shown that effective treatment of depression can be cost-effective. Some key findings include:

• The cost per quality-adjusted life year (QALY) associated with improved depression care ranges from $2,519 to $49,500 2.
• Economic analyses of quality improvement interventions for depression have shown that these interventions can be cost-efficient 3.
• However, barriers to improving depression care exist at various levels, including patient, healthcare provider, practice, plan, and purchaser levels, and may be both economic and non-economic 2.

Management of Economic Burden

To manage the economic burden of depression, various strategies can be employed, including:

• Improving access to and quality of depression treatment, with a focus on evidence-based treatments and care programs 2, 3.
• Addressing barriers to depression care, including patient-level factors such as polypharmacy, anxiety, and substance use disorders 5.
• Providing timely interventions for modifiable risk factors, which may help reduce excess healthcare costs associated with TRD 5.
• Implementing cost-effective treatment strategies, such as those that balance the costs of treatment with the benefits of improved health outcomes 2, 3.