Cost-effectiveness of improved primary care treatment of depression in women in Chile.

BACKGROUND Low- and middle-income countries lack information on contextualised mental health interventions to aid resource allocation decisions regarding healthcare. AIMS To undertake a cost-effectiveness analysis of treatments for depression contextualised to Chile. METHODS Using data from studies in Chile, we developed a computer-based Markov cohort model of depression among Chilean women to evaluate the cost-effectiveness of usual care or improved stepped care. RESULTS The incremental cost-effectiveness ratio (ICER) of usual care was I$113 per quality-adjusted life-year (QALY) gained, versus no treatment, whereas stepped care had an ICER of I$468 per QALY versus usual care. This compared favourably with Chile's per-capita GDP. Results were most sensitive to variation in recurrent episode coverage, marginally sensitive to cost of treatment, and insensitive to changes in health-state utility of depression and rate of recurrence. CONCLUSIONS Our results suggest that treatments for depression in low- and middle-income countries may be more cost-effective than previously estimated.