Wang Philip S, Simon Gregory, Kessler Ronald C
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Int J Methods Psychiatr Res. 2003;12(1):22-33. doi: 10.1002/mpr.139.
Cost-of-illness research has shown that depression is associated with an enormous economic burden, in the order of tens of billions of dollars each year in the US alone. The largest component of this economic burden derives from lost work productivity due to depression. A large body of literature indicates that the causes of the economic burden of depression, including impaired work performance, would respond both to improvement in depressive symptomatology and to standard treatments for depression. Despite this, the economic burden of depression persists, partly because of the widespread underuse and poor quality use of otherwise efficacious and tolerable depression treatments. Recent effectiveness studies conducted in primary care have shown that a variety of models, which enhance care of depression through aggressive outreach and improved quality of treatments, are highly effective in clinical terms and in some cases on work performance outcomes as well. Economic analyses accompanying these effectiveness studies have also shown that these quality improvement interventions are cost efficient. Unfortunately, widespread uptake of these enhanced treatment programmes for depression has not occurred in primary care due to barriers at the level of primary care physicians, healthcare systems, and purchasers of healthcare. Further research is needed to overcome these barriers to providing high-quality care for depression and to ultimately reduce the enormous adverse economic impact of depression disorders.
疾病成本研究表明，抑郁症会带来巨大的经济负担，仅在美国每年就高达数百亿美元。这种经济负担的最大组成部分源于抑郁症导致的工作生产力损失。大量文献表明，抑郁症经济负担的成因，包括工作表现受损，会随着抑郁症状的改善以及抑郁症的标准治疗而得到缓解。尽管如此，抑郁症的经济负担依然存在，部分原因是有效的、可耐受的抑郁症治疗方法普遍未得到充分利用且使用质量不佳。近期在初级保健领域开展的有效性研究表明，通过积极外展和提高治疗质量来加强抑郁症护理的多种模式，在临床方面以及某些情况下对工作表现结果都非常有效。伴随这些有效性研究的经济分析也表明，这些质量改进干预措施具有成本效益。不幸的是，由于初级保健医生、医疗保健系统和医疗保健购买方层面的障碍，这些强化抑郁症治疗方案在初级保健中并未得到广泛采用。需要进一步开展研究，以克服这些障碍，为抑郁症提供高质量护理，并最终减少抑郁症对经济的巨大负面影响。
