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Cost of depression: effect of adherence and treatment response
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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2006 (English)In: European psychiatry, ISSN 0924-9338, Vol. 21, no 6, 349-354 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The purpose of the present study has been to assess the societal cost of major depression and the distribution into different cost components. The impact of adherence and treatment response was also explored.

Method: Data were collected from a randomized controlled trial of patients with major depressive disorder who were treated in a naturalistic primary care setting. Resource use and quality of life were followed during the two-year trial.

Results: The mean total cost per patient during two years was KSEK 363 (EUR 38 953). Indirect costs were the most important component (87%), whereas the cost of drugs was minor (4.5%). No significant differences in costs or quality of life between treatment arms or between adherent and non-adherent patients were demonstrated. However, treatment responders had 39% lower total costs per patient and experienced a larger increase in quality of life compared to non-responders.

Conclusions: Major depression has high costs for society, primarily due to indirect costs. Treatment responders have considerably lower costs per patient and higher quality of life than non-responders. This indicates that measures to increase response rates are also important from an economic perspective.

Place, publisher, year, edition, pages
2006. Vol. 21, no 6, 349-354 p.
Keyword [en]
depression, cost of illness, quality of life, compliance, adherence, response
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95632DOI: 10.1016/j.eurpsy.2006.04.005ISI: 000241090600001PubMedID: 16777385OAI: oai:DiVA.org:uu-95632DiVA: diva2:169927
Available from: 2007-03-29 Created: 2007-03-29 Last updated: 2011-05-31Bibliographically approved
In thesis
1. Adherence to Antidepressant Medication
Open this publication in new window or tab >>Adherence to Antidepressant Medication
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients.

A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years.

Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group.

The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen.

The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders.

Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse.

The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 243
Keyword
Psychiatry, adherence, depression, randomised controlled trial, intervention, therapeutic drug monitoring, personality, health status, health care utilisation, Psykiatri
Identifiers
urn:nbn:se:uu:diva-7769 (URN)978-91-554-6838-5 (ISBN)
Public defence
2007-04-20, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15
Opponent
Supervisors
Available from: 2007-03-29 Created: 2007-03-29Bibliographically approved

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von Knorring, LarsEkselius, Lisa

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