The costs of pharmacological treatment for major depression - The Italian prospective multicentre observational incidence-based study

Objective: To describe the pharmacological treatment for major depression u nder the conditions of routine Italian public mental health facilities, ass ess its costs, and study its main predictors according to a societal perspe ctive. Design: This was a prospective multicentre observational study designed to evaluate the economics of treatment of major depression using a specificall y designed 65-item questionnaire. Data on drug consumption were collected i n a section of the questionnaire and are presented here. Patients and participants: 60 mental health facilities were selected and 55 6 patients were enrolled and followed up for 15 months. Results: Pharmacological treatment appears to be the most common treatment for major depression. 98% of patients were prescribed an antidepressant. Se lective serotonin reuptake inhibitors (SSRIs) were the most prescribed anti depressants. Patients treated with SSRIs suffered from less severe depressi on than those treated with tricyclic antidepressants. Benzodiazepines were prescribed for 84% of patients enrolled. The total drug cost was 1 120 000 Italian lire ($US707) per patient (1995 values). Less than 20% of this cost was borne by the Italian National Health Service, as the majority of drugs used were not reimbursed. Conclusions: The costs of the most widespread approach to treating major de pression (pharmacological treatment) are not currently covered by the Itali an National Health Service. Prescribing of drugs seems to diverge from the standards of treatment indicated by the Italian Drug Committee.