Masoumeh Amin-Esmaeili
1 
, Shahab Baheshmat
2, Afarin Rahimi-Movaghar
3* , Seyed Mehdi Samimi Ardestani
4, Roya Samadi
5, Ahmad Hajebi
6, Yosef Farzy
7, Ebrahim Moghimi-Sarani
8, Shahab Khatibzadeh
9, Saeid Shahraz
101 Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
2 Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
3 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
4 Departments of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
6 Research Center for Addiction and Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
7 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
8 Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
9 Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
10 Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA, United States
Abstract
Background: Major depressive disorder (MDD), a major cause of the burden of diseases, is associated with a considerable rate of inadequate treatment and high costs. We assessed the pattern of service use, quality, and costs of healthcare for MDD in Iran.
Methods: We assessed a national sample of 265 patients in the acute phase of MDD recruited from outpatient/inpatient settings at baseline and in three follow-up points of one, three, and six months. The pattern of service use and selected quality indicators were assessed, and the costs of care for an episode of MDD were estimated using the bottom-up approach.
Results: The subjects were primarily female (73.6%), with a mean age of 43.3 years (±13.8). Of 173 respondents at the end of the study, 65.3% were on treatment for at least six months. Regarding quality indicators, the majority of the patients (97.7%) were prescribed antidepressants. However, only 71.2% of the patients initiated their antidepressants following prescription at the initial visit. At the end of the study, 40.1% were in remission and 58.1% had at least a 50% improvement in depressive symptoms. However, no standardized process or outcome measures were documented on the patients’ medical records. The average out-of-pocket and total costs for an episode of MDD per patient were estimated at Int$ 1331.4 and 2107.4, respectively.
Conclusion: We recommend establishing an infrastructure for monitoring the clinical evaluation and treatment, and proper documentation based on standard quality of care, especially for ambulatory clinical practice.