Abstract

Background: Current estimates of the societal costs of depression do not include estimates of how much individuals diagnosed with Major Depressive Disorder (MDD) would be willing to pay to eliminate their depression or how much they would have to be paid in order to accept continued depression. Choice experiment data and discrete-choice random-utility models provide a useful method for valuing changes in mental health and mental-health treatment programs. Aims of the study: (1) To demonstrate how choice questions and discretechoice random-utility models can be used to estimate preferences over treatment programs for depression and willingness-to-pay (WTP ) to eliminate depression. (2) To model and estimate the magnitude of the anhedonia impact of depression: consumption provides less utility when one is depressed. (3) To model heterogeneity in preferences for treatment programs for depression. (4) To derive preliminary estimates of WTP and willingness-to-accept (WTA) for eliminating and reducing depression, both with, and without side effects. Methods: The data are from a choice experiment survey of 104 individuals diagnosed with a new episode of MDD. Individuals indicated their preferred treatment from options that varied in effectiveness, hours of psychotherapy per month, use of anti-depressants, money costs, and side effects (weight gain, little or no interest in sex, inability to orgasm). Choices over treatment alternatives, including no treatment, were modeled using a discrete-choice randomutility model. Preference parameters were estimated using maximum likelihood estimation. Results and Discussion: Estimated WTP to eliminate MDD is large but side effects can substantially reduce WTP . Preferences over treatment programs, and WTP , vary as a function of the individual’s age, gender, income category, body-mass-index, and family composition. Some depressed individuals seeking treatment have a high estimated probability of choosing no treatment. Depression has both a direct and indirect effect on utility. The indirect effect on utility (the anhedonia effect), where the utility from consumption varies with emotional state, causes a divergence between WTP and WTA. The results may only be generalizable to those who are referred to or directly seek treatment at a mental-health clinic and should be replicated with a larger sample. Implications: The WTP estimates suggest that depression imposes a high cost on society beyond the cost of treatment and the cost of lost output. Willingness-to-pay should be included in any benefit-cost analysis of whether additional societal resources should be allocated to the treatment of depression. Side effects from anti-depressants also impose a large cost on society. Estimates such as the ones reported here could provide a mechanism for better matching treatment programs to the patient and thus potentially minimizing non-adherence. The WTP estimates suggest that the pharmaceutical industry could earn significant revenues by making anti-depressants more effective, reducing their side effects, or both.