The economic burden of depression and reimbursement policy in the Asia Pacific region.

OBJECTIVE: To determine the economic burden of depression in the Asia Pacific region, review the negative economic consequences attributable to depression, and describe the reimbursement policies for health-care services throughout the Asia Pacific region.

METHODS: Both direct and indirect costs were obtained via a literature review of international mental health journals. Disability adjusted life year (DALYs) estimates were obtained from the World Health Organization. Reimbursement policy data were obtained from personal communication with the SEBoD International Advisory Board.

RESULTS: There are only two studies of the economic costs of depression in the Asia Pacific region. From these, the total cost of depression in Australia for 1997-98 was estimated as US$1.8 billion (22% direct costs), and in Taiwan for 1994 as US$1.4 billion (25% direct costs). In the year 2000, it was estimated that unipolar major depression accounted for 14.2 million DALYs in China and 22.7 million DALYs for all other Asia Pacific countries. The majority of Asia Pacific health-care systems have extensive insurance coverage, but not specific provisions for depression. However, relatively low overall fee schedules diminish financial barriers for outpatient treatment of depression.

CONCLUSIONS: Untreated depression is a very costly disorder across the Asia Pacific region, with indirect costs constituting a substantial proportion. Consequently, treatment of depression should be the focus of policy makers to avoid major negative cost repercussions. It is encouraging that most Asia Pacific health service reimbursement policies enable the treatment of depression (especially outpatient treatment) to be relatively affordable. To advance this issue, the paucity of specific information on the epidemiology of depression, as well as service use and cost, needs to be addressed.