Quality of Service and Cost of Managing an Episode of Major Depressive Disorder: A Cohort Study in Iran.

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.