Costing depression and its management: an Australian study

Costs of the principal mood disorders: a study of comparative direct and indirect costs incurred by those with bipolar I, bipolar II and unipolar disorders

BACKGROUND

While there have been many studies comparing direct and indirect costs engendered individually and nationally by those with unipolar (UP) and bipolar (BP) disorders, there has been no previous study comparing costs across the bipolar I (BP I) and bipolar II (BP II) disorders.

METHODS

We examine direct and indirect costs attributable to a mood disorder in a sample of 44 BP I, 102 BP II and 279 UP patients attending a tertiary referral clinic, and with comparable illness durations of some 20 years and comparable treatment durations. We calculated direct and indirect costs incurred for their lifetime of illness based on relevant cost structures, in Australian dollars.

RESULTS

The mean lifetime indirect costs for BP I patients was $134,318, as against $76,821 for BP II and $68,347 for UP patients, joining with respective health care costs of $26,353, $17,580 and $27, 237, to generate total costs of $160,671/BP I patient, $94,401/BP II patient and $95,584/UP patient. BP I patients differentiated most distinctly in costs as a consequence of a higher prevalence of government benefits, time off work and longer periods in hospital. UP patients had more stable work histories than both BP sub-sets. BP II patients were less likely to be hospitalised than both the BP I and UP patients.

LIMITATIONS

Being drawn from a tertiary referral clinic, the study sample is not necessarily representative, with this nuance potentially having influenced cost differences between groups.

CONCLUSIONS

This is the first cost of illness study directly comparing BP I and BP II patients (and with an additional comparison group of UP patients). Findings indicate that BP I illness generates more direct and indirect costs than BP II illness, while the latter was generally comparable with UP depression in terms of the lifetime cost.

The excess cost of depression in South Australia: a population-based study

OBJECTIVE

To establish excess costs associated with depression in South Australia, based on the prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD)) and associated excess burden of depression (BoD) costs.

METHOD

Using data from the 1988 South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of SA adults, we calculated excess costs using two methods. First, we estimated the excess cost based on health service provision and loss of productivity. Second, we estimated it from loss of utility.

RESULTS

We found symptoms of major depression in 7% of the SA population, and 11% for other depression. Those with major depression reported worse health status, took more time off work, reported more work performance limitations, made greater use of health services and reported poorer health-related quality-of-life. Using the service provision perspective excess BoD costs were AUD$1921 million per annum. Importantly, this excluded non-health service and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD$50 000), the estimate was AUD$2800 million. This reflects a societal perspective of the value of illness, hence there is no particular reason the two different methods should agree as they provide different kinds of information. Both methods suggest estimating the excess BoD from the direct service provision perspective is too restrictive, and that indirect and societal costs ought be taken into account.

CONCLUSIONS

Despite the high ranking of depression as a major health problem, it is often unrecognized and undertreated. The findings mandate action to explore ways of reducing the BoD borne by individuals, those affected by their illness, the health system and society generally. Given the limited information on the cost-effectiveness of different treatments, it would seem important that resources be allocated to evaluating alternative depression treatments.