Major depressive disorders are one of the most common mental illnesses. Over the next decade, depression is set to become the world’s leading cause of disability as it directly affects the patient’s ability to work.
Canadian health systems pay for MDD treatment through pharmaceutical therapies and visits to physicians, hospitals and emergency departments. However, the costs of psychotherapy or pharmacology treatments are not fully covered, nor do all Canadians have access to extended health benefits, meaning they must pay out-of-pocket. Other costs, like lost productivity and informal caregiving, are also borne by the patient and their family.
The study found that costs over the first 12 weeks after diagnosis are high but decrease if the depression is successfully managed. However, if the treatment is unsuccessful, those costs remain high and can become a financial burden, particularly for low-income households.
For example, in the first 12 weeks after diagnosis, a patient with severe depression will have health system costs averaging $138/week, while simultaneously costing the patient and their family $735/week in depression-attributable costs. If treated successfully, those costs drop to $65/week for the health system and $80/week for the patient and their family. However, if treatment is unsuccessful, the cost to the health system reduces slightly to $125/week while the costs to patients and their family increases to $1,021/week.
The study also examined the distribution of expenditure proportions, the amount that is paid relative to a patient’s income, using a World Health Organization-defined threshold for financial hardship. It found that lower income groups and people in urban centres are more at risk of financial hardship.
“Even in high-income Canada, our health-care systems come close to failing to meet their core objective of protecting patients from impoverishing health-related spending,” said Cressman, adding that rapid access to effective treatments and achieving remission early could mitigate financial hardship for patients across income levels.
She hopes the study leads to national policy in Canada to protect patients with mental illness from the financial impacts of their condition. The study was nested within a project, jointly funded by Genome B.C., Genome Canada, and the Michael Smith Health Research B.C., to develop a genomic test to better predict early treatment to help reduce the costs to the health system and the patient.