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Reducing the global burden of depression: Population-level analysis of intervention cost-effectiveness in 14 world regions

  • Dan Chisholm (a1), Kristy Sanderson (a2), Jose Luis Ayuso-Mateos (a3) and Shekhar Saxena (a4)

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce.


To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden.


Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios.


Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions.


Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantly if there is a substantial increase in treatment coverage.

Corresponding author
Dan Chisholm, CEP Team (Room 3169), Department of Health System Financing, Expenditure and Resource Allocation, Evidence and Information for Policy, World Health Organization, 1211 Geneva, Switzerland; e-mail:
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See pp. 386–392 and editorial, pp. 379–380, this issue.

Declaration of interest


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Reducing the global burden of depression: Population-level analysis of intervention cost-effectiveness in 14 world regions

  • Dan Chisholm (a1), Kristy Sanderson (a2), Jose Luis Ayuso-Mateos (a3) and Shekhar Saxena (a4)
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