Depression, Anxiety Interventions Pay Enormous Dividends

By John Henry Dreyfuss, MDalert.com staff.

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  • Increased investment treatment of people with anxiety or depressive symptoms would significantly increase productivity in the 36 largest nations on earth.
  • An investment of US$147 billion over 14 years would result in a return of $230 billion for depression treatment and $169 billion for improvement in people with anxiety in terms of improved productivity and reduced absenteeism and presenteeism.
  • The benefit-to-cost ratios of increased investment in treatment of anxiety and depression range from 2.3 to 3.0:1 when economic benefits only are considered, and 3.3 to 5.7:1 when the value of health returns are also included.
  • Few health interventions are as cost effective.
  • For malaria, the estimated benefit-to-cost ratios are calculated to be in the range of 28:1 to 40:1.

A significant investment in the treatment of anxiety and depressive disorders would lead to an enormous positive return on investment according to a recent report in The Lancet. A net present value of investment US$147 billion is needed over the period 2016 to 2030 to in order to substantially improve treatment for anxiety disorders (Figure 1) and depression (Figure 2), according to The Lancet report.

 

Figure 1. The lifetime prevalence of anxiety disorders.

 

Figure 2. International epidemiology of depressive disorders.
An investment of this magnitude could result in a return of $230 billion for depression (Figure 3) treatment and $169 billion for improvement in people with anxiety (Figure 4) in terms of improved productivity and reduced absenteeism and presenteeism (employees present at the workplace but suboptimally productive). Such an investment could yield 43 million extra years of healthy life and a large economic return on these extra years of healthy life. These scaled up treatments of common mental disorders would lead to significant economic productive gains. Across country income groups, resulting benefit-to-cost ratios were calculated at 2.3 to 3.0:1. When economic benefits only were considered, the benefit-to-cost ratios were calculated at 3.3 to 5.7:1.
Figure 3. The costs of depressive disorders.

Figure 4. Components of the society costs of depression.

“Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders,” the authors wrote.

“Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide,” The Lancet authors noted.

The Analysis

In this global return on investment analysis, the authors used the mental health module of the OneHealth tool in order to calculate treatment costs and health outcomes in 36 countries in a forecast of the period between 2016 and 2030. “We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labor participation and gross domestic product (GDP) per worker in each country,” they explained.

The analysis examined the world’s 36 largest countries. If the of care for people with anxiety (Figure 5) and depression (Figure 6) are maintained at current levels in these countries – without scale up, as The Lancet authors explained it, more than 12 billion days of lost productivity (equivalent to more than 50 million years of work) would be attributed to depression and anxiety disorders every year. The cost of these untreated disorders was estimated at US$925 billion.

Figure 5. Depression can be physically and emotionally crippling.
Figure 6. Anxiety disorders can lead to social isolation an enormous costs of lost productivity.
If the costs were modeled across lower-income and higher-income countries, these figures would hold for all other countries. This figure represents 20% of the world’s population. The global cost per year is $1·15 trillion. “Compared with people without these disorders, 4·7 billion extra days are lost, at a cost of $592 billion (36% of the total cost); this figure can be termed the excess productivity loss of these disorders,” the authors explained.

When the authors examined the cost of scaling up treatment for depression and anxiety—expressed as the cumulative cost over 15 years of steady scale-up, but discounted at a rate of 3%—these costs relate to incremental treatment of affected members of the population in excess of current levels of coverage. “For all 36 countries, the total cost amounts to US$91 billion for depression and $56 billion for anxiety disorders,” the authors explained. “Treatment of mild cases accounts for less than 10% of total costs for depression and 20% for anxiety disorders. After standardizing for population size, the cost is actually quite low; for depression treatment, the average annual cost during 15 years of scaled-up investment is $0·08 per person in low-income countries, $0·34 in lower middle-income countries, $1·12 in upper middle-income countries and $3·89 in high-income countries. Per person costs for anxiety disorders are nearly half that of depression.”

Figure 7. Anxiety by Edvard Munch.
 Conclusions and Discussion

This analysis sets out, for the first time, a global investment case for a scaled-up response to the massive public health and economic burden of depression and anxiety disorders. “The analysis suggests that the investment needed to substantially scale up effective treatment coverage for depression and anxiety disorders in the 36 countries included in this analysis is substantial. However, the net present value of all investments between 2016 and 2030 is $147 billion, equivalent to less than $10 billion per year on average. Extending the scope to the 20% of the world’s population not living in the 36 countries represented in the study would increase the cost by about 25% to $184 billion,” The Lancet authors describe.

However, the returns to this investment are also substantial, with benefit to cost ratios of 2.3 to 3.0:1 when economic benefits only are considered, and 3.3 to 5.7:1 when the value of health returns are also included. “To put these findings into context, any benefit-to-cost ratio exceeding 1 provides a rationale for investment. Compared with some other potential investments in health, ratios of the order reported here can be deemed relatively modest. For example, a return on investment analysis for malaria, also for 2016–30, but using the full value of a statistical life-year, estimated benefit to cost ratios in the range of 28:1 to 40:1,” the authors concluded.


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