By Aiswariya Chidambaram, Healthcare

Major depressive disorder and bipolar disorder are the two major disorders among the spectrum of mood disorderswhich incur massive healthcare costs to the European Government. The total number of individuals with mood disordersin Europe is estimated to be 33.3 million in 2011, of which nearly 29 million people are diagnosed with unipolar depression and more than3 million people with bipolar disorder. As per the estimates of the European Brain Council (EBC), the average prevalence rate of major depressive disorder and bipolar disorder were 6.9 per cent (18 years and above) and 0.9 per cent (18 - 65 years),respectively, in Europe. Mood disorders are doomed to be the most expensive among the various brain disorders, accounting for 14.2 per cent of the total brain disorder expenditure in Europe, thereby posing a great challenge to the European Government to curb the rising healthcare costs.

Cost Analysis of Mood Disorders

The annual cost of mood disorders in Europe peaked to €113.41 billion in 2010, with average annual cost per person being €3,406. The costs are on an increasing curve as more people fall prey to affective disordersdueto changing lifestyle patterns. The total costs associated with mood disorders can be classified into three broad categories,namely direct healthcare costs, direct non-medical costs and indirect costs. The direct healthcare costs includeexpenditure on medication, hospitalisation, emergency room visits, outpatient, psychiatric, physician and other mental-health providers. Non-medical costs comprise special accommodation for patients, informal care, transportation to obtain healthcare and support costs of criminal justice system, whereas indirect costs constitute losses in productivity, unemployment, morbidity, stress and time taken off from work by relatives and care-takers of patients. It is alarming to note that the indirect costs associated with mood disorders account for nearly 60 to 80 per cent of the total expenditure.

Economic Burden Due to Bipolar Disorder

The average annual expenditure due to bipolar disorder in Europe was estimated to be €38,547 million in 2011, and the average annual cost per bipolar disorder patient was estimated to be €8,379.8. The direct healthcare costs, direct non-medical costs and indirect costs per person were estimated to be €535.7, €514.8 and €7,329.3, respectively. The direct healthcare costs of bipolar disorder are likely to reduce significantly over the next few yearsdueto the patent expiry of leading blockbuster atypical antipsychotics approved for bipolar disorder, which include Seroquel® IR (quetiapine fumarate) from AstraZeneca, Geodon® (ziprasidone) from Pfizer, Abilify® (aripiprazole) from Bristol-Myers Squibb and Saphris® (asenapine) from Merck. Recently, the leading atypical antipsychotic Zyprexa® (olanzapine) from Eli Lilly lost its patent protection in April 2011. Thus, the direct costs of drugs are likely to reduce between 30 and 60 per cent, as cheaper generic equivalents become available in the market;nevertheless,managing the indirect costs, which are more than five times the direct costs, still remains a challenge. However, with the approval of newer drugs and launch of improved drug formulations such as depot formulations, the costs of bipolar disorder medication are expected to surge between 2013 and 2018.

Economic Burden Due to Major Depressive Disorder

Major depressive disorder, also referred to as unipolar depression,constitutes two-thirds of the costs incurred due to mood disorders in Europe, primarily due to the wide prevalence of the disease in the population group above 18 years of age. The average annual costs due to major depressive disorder were estimated to be €74,858 million in 2011. However, the direct costs associated with anti-depressant drugs have constantly been decreasing with five blockbuster anti-depressants having lost patent protection during the period 2006 to 2010, which include Paxil® from GlaxoSmithKline, Zoloft® and Effexor® from Pfizer, Prozac® from Eli Lilly and Remeron® from Merck. Moving ahead, leading blockbuster drugs such as Cymbalta® from Eli Lilly and Cipralex® from Lundbeck are due to lose their patent protection in 2014. With very few potential drug candidates in pipeline, the direct costs of anti-depressant drugs are expected to decline by 50 per cent over the next five years (until 2016).

Increasing Cost Containment Measures to Curb Rising Costs - Facing the Challenge

The European Government is under immense pressure to control the rising healthcare costs of mood disorders, which has led to drug choices based on cost-effectiveness, dictating the use of specific drugs in certain circumstances. Additionally, the use of several mood disorder drugs, whether approved for monotherapy or adjunct therapy, is restricted to the refractory patient population. This, in turn, limits the potential profit margins for other pharmaceutical companies in the European mood disorder therapeutics market. Nevertheless, the indirect costs of mood disorders such as emergency admissions, suicide, and unemployment are also high and needs to be addressed adequately. Therefore, the challenge is to view the problem at a broader perspective and increase the awareness of both direct as well as indirect costs of mood disorders among medical practitioners, policy-makers and the government. Increased awareness of the disorder among the patients and physicians coupled with timely psychological intervention can help reduce indirect costs of mood disorders.