A review of the costs associated with depression and treatment noncompliance: the potential benefits of online support.

This systematic review examines the economic and human costs of depression and the potential savings associated with improvement in patient adherence to treatment with antidepressants through the use of enhanced-care programs. A MEDLINE search was conducted for papers published on the health economics and costs of depression and compliance, adherence, and persistence. Compliance data collected through the online antidepressant compliance support website iCAN (www.ican.co.uk) were compared with data for patients with depression from the IMS Disease Analyzer UK database. Depression frequently causes unemployment, absenteeism, and presenteeism, which results in significantly reduced productivity. Indirect costs of depression accounted for more than $50 billion, whereas direct costs resulted in expenditure of $26 billion, in the US in 2000. Improving patients' compliance with their antidepressant medication results in improved outcomes and prolongs remission from depression, increasing work productivity, and thus reducing overall costs. The implementation of remote enhanced-care programs may improve compliance and reduce overall costs. Novel methods for delivering enhanced-care programs to assist in maintaining compliance have the potential to further reduce costs and should be a focus of future research. In conclusion, depression is a common disorder with a high economic impact. Enhanced-care programs may lower costs associated with depression and improve patients' lives.