https://orcid.org/0000-0002-6391-6791
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ABSTRACT
Background/objectives: Major depression has a negative impact on quality of life, increasing the risk of premature death. It imposes social and economic costs on individuals, families and society. Mental illness is now the leading cause globally of disability/lost quality life and premature mortality. Finding cost-effective treatments for depression is a public health priority. We report an economic evaluation of a dietary intervention for treating major depression.
Methods: This economic evaluation drew on the HELFIMED RCT, a 3-month group-based Mediterranean-style diet (MedDiet) intervention (including cooking workshops), against a social group-program for people with major depression. We conducted (i) a cost-utility analysis, utility scores measured at baseline, 3-months and 6-months using the AQoL8D, modelled to 2 years (base case); (ii) a cost-effectiveness analysis, differential cost/case of depression resolved (to normal/mild) measured by the DASS. Differential program costs were calculated from resources use costed in AUD2017. QALYs were discounted at 3.5%pa.
Results: Best estimate differential cost/QALY gain per person, MedDiet relative to social group was AUD2775. Probabilistic sensitivity analysis, varying costs, utility gain, model period found 95% likelihood cost/QALY less than AUD20,000. Estimated cost per additional case of depression resolved, MedDiet group relative to social group was AUD2,225.
Conclusions: A MedDiet group-program for treating major depression was highly cost-effective relative to a social group-program, measured in terms of cost/QALY gain and cost per case of major depression resolved. Supporting access by persons with major depression to group-based dietary programs should be a policy priority. A change to funding will be needed to realise the potential benefits.
Disclosure statement
No potential conflict of interest was reported by the authors.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Notes on contributors
Professor Leonie Segal has a Ph.D. in Economics and has held the Foundation Chair Health Economics and Social Policy at the University of South Australia since 2007. The purpose of her research is to improve the life chances of society’s most vulnerable populations. This is pursued through cutting edge research working in partnership with clinicians, service providers and government to conduct policy-driven research to achieve evidence informed policy and practice. Economic evaluation alongside clinical trials forms a core part of her work. Segal has a record of >120 economic evaluations, covering all health modalities, especially life-style interventions. Her published cost–utility (C-U) analysis of 10 nutrition interventions in 2007 was the largest study of its kind and still represents a major contribution to the literature on the economic performance of dietary interventions. She has also published on nutrition policy to support desired changes in citizen and clinician behaviour.
Dr Asterie Twizeyemariya has a Ph.D. in Economics. Her research interests include using methods such as economic evaluation, economic modelling, policy analysis, statistical analysis, evidence synthesis, research translation and uptake, budgeting, planning, and self-management to learn about behaviour and risk factors that affect individuals and to estimate population health outcomes.
Dr Dorota Zarnowiecki has a Ph.D. in Nutrition and is currently at Flinders University, Adelaide, Australia. As a post-doctoral research fellow at the University of South Australia, she was on a team led by Dr Natalie Parletta to extend the group diet HELFIMED program for including Mediterranean-style diets into rehabilitation programs with people who have mental illness in a randomised controlled trial to people suffering depression (now published: https://doi.org/10.1080/1028415X.2017.1411320).
Dr Theo Niyonsenga is Associate Professor in the Centre for Research and Action in Public Health, University of Canberra. He has a Ph.D. in Mathematical Statistics and more than 20 years of experience in statistical data analysis and consulting. His interests are in developing and applying statistical methodology to collaborative health research focusing on various areas of Biostatistics in general (e.g. generalized linear models, survival analysis) and in particular on spatial statistics with applications to spatial epidemiology, multivariate data analysis methods (such as structural equations modelling) as well as both growth curve hierarchical data modelling. His research interests include quantitative research within spatial epidemiology and evaluation research (hierarchical growth models and spatial clustering models) and environmental and social determinants of health.
Dr Svetlana Bogomolova is Associate Professor and Senior Marketing Scientist at the Ehrenberg-Bass Institute for Marketing Science at the University of South Australia. Her research interests include consumer food choices in a supermarket and the influence of price promotions, in-store signage, packaging, nutrition, region-of-origin labelling and other elements of the shopping environment on shopper decisions. Her current projects focus on healthiness of food choices and support for locally produced foods. This work advances important emerging cross-disciplinary areas of Health Marketing and Social Marketing.
Amy Wilson is a research associate at the Ehrenberg-Bass Institute, University of South Australia and a Ph.D. candidate in Marketing. Her cross-disciplinary research combines theory and research from Marketing, Social Marketing, Behavioural Economics and Nutrition to encourage consumers to engage in healthier behaviours.
Dr Kerin O'Dea is Emeritus Professor: Nutrition and Population Health in the School of Health Sciences, University of South Australia. As a scientist, she has made major contributions to understanding the relationship between diet and chronic diseases, particularly type 2 diabetes and CVD. She is probably best known for her novel research on the marked beneficial health impact of temporary reversion to traditional hunter-gatherer lifestyle on diabetes and associated conditions in Australian Aborigines. This led to a strong research interest in the therapeutic potential of traditional diets and lifestyles.
Dr Natalie Parletta is an Adjunct Senior Research Fellow at the University of South Australia, nutritionist and freelance science writer. She has a PhD, Bachelor of Psychology (first-class Honours) and a Master of Dietetics. For more than 10 years she has researched links between nutrition and mental health, parental influences on child and adolescent diets and benefits of the Mediterranean diet for heart and mental health. Dr Parletta developed a group diet program (HELFIMED) for including Mediterranean-style diets into rehabilitation programs with people who have mental illness, in collaboration with Outer South Mental Health, Southern Adelaide Local Health Network. With postdoctoral research fellow Dorota Zarnowiecki, her team extended this program in a randomised controlled trial to people suffering depression (now published: https://doi.org/10.1080/1028415X.2017.1411320).