Considering the societal perspective in economic evaluations: a systematic review in the case of depression
Open accessAbstract
Background: Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. Methods: A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008–2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. Results: Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. Conclusions: Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
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YAM was compared to gatekeeper training in a randomized trial and found to be more effective.
“YAM was compared to gatekeeper training in a randomized trial and found to be more effective. 383”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [383]
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Vataire, A. L., Aballéa, S., Antoñanzas, F., Roijen, L. H., Lam, R. W. M., McCrone, P., Persson, U., & Toumi, M. (2014) · Value in Health · doi:10.1016/j.jval.2013.11.012 · Cited by 15 · see citing works
Choi, S.-E., Brignone, M., Cho, S. J., Jeon, H. J., Jung, R., Campbell, R., François, C., & Milea, D. (2015) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.2016.1128830 · Cited by 14 · see citing works
(2009) · PubMed · Cited by 12 · see citing works
Nordstrom, G., Danchenko, N., Despiégel, N., & Marteau, F. (2012) · Value in Health · doi:10.1016/j.jval.2011.09.011 · Cited by 11 · see citing works
Meuldijk, D., Carlier, I. V. E., van Vliet, I. M., van Hemert, A. M., Zitman, F. G., & Marle, M. E. V. D. A. (2015) · PubMed · Cited by 11 · see citing works
Brettschneider, C., Kohlmann, S., Gierk, B., Löwe, B., & König, H.-H. (2017) · PLoS ONE · doi:10.1371/journal.pone.0181021 · Cited by 11 · see citing works
Fluoxetine and imipramine: are there differences in cost‐utility for depression in primary care?
Serrano‐Blanco, A., Suarez, D. L., Pinto‐Meza, A., Peñarrubia‐María, M. T., Haro, J. M., & DAPGA Group (Depressió en Atenció Primària de Gavà) (2009) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2008.00982.x · Cited by 10 · see citing works
Nordstrom, G., Despiégel, N., Marteau, F., Danchenko, N., & Maman, K. (2010) · Journal of Medical Economics · doi:10.3111/13696998.2010.506371 · Cited by 10 · see citing works
Oliva, J., Brosa, M., Espín, J., Figueras, M., & Trapero‐Bertran, M. (2015) · Revista Española de Salud Pública · doi:10.4321/s1135-57272015000100002 · Cited by 9 · see citing works
Cost-Effectiveness of Escitalopram in Major Depressive Disorder in the Dutch Health Care Setting
Nuijten, M. J. C., Brignone, M., Marteau, F., den Boer, J. A., & Hoencamp, E. (2012) · Clinical Therapeutics · doi:10.1016/j.clinthera.2012.04.006 · Cited by 9 · see citing works
Biesheuvel-Leliefeld, K. E. M., Bosmans, J. E., Dijkstra‐Kersten, S. M. A., Smit, F., Bockting, C., van Schaik, A., van Marwijk, H., & van der Horst, H. E. (2018) · PLoS ONE · doi:10.1371/journal.pone.0208570 · Cited by 6 · see citing works
The Inclusion of Spillover Effects in Economic Evaluation: A Public Health Economics Perspective
Edwards, R. T. (2018) · PharmacoEconomics · doi:10.1007/s40273-018-0748-9 · Cited by 3 · see citing works
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Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Shen, J., Begum, N., García, Y. R., Martinón‐Torres, F., Bekkat-Berkani, R., & Meszaros, K. (2022) · BMC Public Health · doi:10.1186/s12889-022-13342-2 · Cited by 75 · see citing works
Jiang, S., Wang, Y., Si, L., Zang, X., Gu, Y., Jiang, Y., Liu, G. G., & Wu, J. (2022) · BMJ Global Health · doi:10.1136/bmjgh-2022-009777 · Cited by 46 · see citing works
Societal costs and health related quality of life in adult atopic dermatitis
Beretzky, Z., Koszorú, K., Rencz, F., Hajdu, K., Borza, J., Bodai, K., Feifei, X., Szegedi, A., Sárdy, M., & Brodszky, V. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09840-7 · Cited by 27 · see citing works
Rodríguez-Sánchez, B., Aranda-Reneo, I., Oliva, J., & López‐Bastida, J. (2021) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s301589 · Cited by 23 · see citing works
Self-citationOn spillovers in economic evaluations: definition, mapping review and research agenda
Mendoza-Jiménez, M. J., van Exel, J. N. A., & Brouwer, W. B. F. (2024) · The European Journal of Health Economics · doi:10.1007/s10198-023-01658-8 · Cited by 19 · see citing works
One-year direct and indirect costs of ischaemic stroke in China
Lv, W., Wang, A., Wang, Q., Wang, R., Xu, Q., Wu, S., Han, Y., Jiang, Y., Lin, J., Jing, J., et al. (2023) · Stroke and Vascular Neurology · doi:10.1136/svn-2023-002296 · Cited by 18 · see citing works
Rodríguez-Sánchez, B., Daugbjerg, S. B., Peña-Longobardo, L. M., Oliva, J., Aranda-Reneo, I., Cicchetti, A., & López‐Bastida, J. (2022) · The European Journal of Health Economics · doi:10.1007/s10198-022-01471-9 · Cited by 16 · see citing works
Self-citationGalván, F. H., Liu, H., Brooks, R. A., Chen, Y.-T., & Lepe, R. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268406 · Cited by 14 · see citing works
Asukai, Y., Briggs, A. H., Garrison, L. P., Geisler, B. P., Neumann, P. J., & Ollendorf, D. A. (2021) · PharmacoEconomics · doi:10.1007/s40273-021-01088-5 · Cited by 13 · see citing works
Value is Gendered: The Need for Sex and Gender Considerations in Health Economic Evaluations
Mchenga, M., Vijayasingham, L., RamPrakash, R., & Remme, M. (2024) · Applied Health Economics and Health Policy · doi:10.1007/s40258-024-00930-z · Cited by 12 · see citing works
Yuasa, A., Yonemoto, N., Kamei, K., Murofushi, T., LoPresti, M., Taneja, A., Horgan, J., & Ikeda, S. (2022) · Advances in Therapy · doi:10.1007/s12325-022-02321-z · Cited by 11 · see citing works
Hosseini Jebeli, S. S., Rezapour, A., Hajebi, A., Moradi-Lakeh, M., & Damari, B. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00468-w · Cited by 10 · see citing works
Hafner, M., Yerushalmi, E., Andersson, F., & Burtea, T. (2022) · Health Economics · doi:10.1002/hec.4638 · Cited by 9 · see citing works
Crosland, P., Ho, N., Nguyen, K., Tran, K., Hosseini, S. H., Vacher, C., Skinner, A., van Rosmalen, J., Rosenberg, S. P., Iorfino, F., et al. (2025) · Nature Mental Health · doi:10.1038/s44220-025-00459-7 · Cited by 7 · see citing works
Growth and changing landscape of the cost-utility literature: an Australian perspective, 1992-2022
Xia, Q., McPhail, S., Afoakwah, C., Vo, L. K., Lim, M. H. A., Brain, D., Kuwornu, J. P., & Carter, H. E. (2025) · Health Policy · doi:10.1016/j.healthpol.2025.105319 · Cited by 6 · see citing works
Seddik, A. H., Paulissen, J. H. J., Marapin, R. S., Fuhler, S., Johal, S., Rosenlund, M., Dunton, K., Postma, M. J., & Freriks, R. (2025) · Value in Health · doi:10.1016/j.jval.2025.02.009 · Cited by 4 · see citing works
Advancing the economics of prevention: emerging methods and approaches
Grimm, S. E., van Mastrigt, G. A. P. G., & Hiligsmann, M. (2025) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2025.2570689 · Cited by 4 · see citing works
Yousefi, M., Mehrabian, A., Brown, A., Butt, F., Donoghue, J., Parr, J., Patel, M., Grove, A., Parsons, J., & Auguste, P. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-04150-z · Cited by 4 · see citing works
Kohrt, B. A., Wahid, S. S., Ottman, K. E., Burgess, A., Viduani, A. C., Martini, T., Benetti, S. P. D. C., Momodu, O., Bohara, J., Neupane, V., et al. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.136 · Cited by 4 · see citing works
Out of Date or Best Before? A Commentary on the Relevance of Economic Evaluations Over Time
Shields, G., Pennington, B., Bullement, A., Wright, S. J., & Elvidge, J. (2021) · PharmacoEconomics · doi:10.1007/s40273-021-01116-4 · Cited by 4 · see citing works
The conceptualisation of cardiometabolic disease policy model in the UK
Putri, S., Ciminata, G., Lewsey, J., Jani, B., McMeekin, N., & Geue, C. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-11559-y · Cited by 4 · see citing works
Tang, M., Ai, Y., Song, N., Xu, X., Geng, L., Chen, D., Ren, L., Chen, X., Chen, J., Zhang, L., et al. (2024) · Journal of Essential Oil Bearing Plants · doi:10.1080/0972060x.2024.2302410 · Cited by 3 · see citing works
Palmer, A. J., Zhao, T., Taylor, B. V., van der Mei, I. A. F., & Campbell, J. A. (2023) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2023-332161 · Cited by 2 · see citing works
Costs of major depression covered / not covered in British Columbia, Canada
Cressman, S., Ghanbarian, S., Edwards, L., Peterson, S., Bunka, M., Hoens, A. M., Riches, L., Austin, J., Vijh, R., McGrail, K. M., et al. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-10474-y · Cited by 2 · see citing works
Bariatric Surgery, Employment, and Productivity Outcomes
Xia, Q., Donovan, T., Diao, J., Yang, X., Jin, X., Lartey, S. T., & Carter, H. E. (2025) · JAMA Surgery · doi:10.1001/jamasurg.2025.3611 · Cited by 1 · see citing works
Tran, P. B., Berete, F., Clercq, B. D., der Heyden, J. V., van Olmen, J., & Willem, L. (2025) · European Journal of Public Health · doi:10.1093/eurpub/ckaf063 · Cited by 1 · see citing works
Measuring and valuing spillover effects in caregivers and families: A scoping review
Dang, T. T. H., Tabinga, A., Beilby, H., Barker, N., Johnson, L. R., Tuffaha, H., Connelly, L. B., & Maguire, A. M. (2026) · PLoS ONE · doi:10.1371/journal.pone.0337253 · Cited by 1 · see citing works
Fatoye, F., Gebrye, T., Nherera, L. M., & Trueman, P. (2024) · Journal of Market Access & Health Policy · doi:10.3390/jmahp12030018 · Cited by 1 · see citing works
Jebeli, S. S. H., Rezapour, A., Hajebi, A., Moradi‐Lakeh, M., & Damari, B. (2021) · Research Square · doi:10.21203/rs.3.rs-52097/v2
Additional file 1 of Costs of major depression covered / not covered in British Columbia, Canada
Cressman, S., Ghanbarian, S., Edwards, L., Peterson, S., Bunka, M., Hoens, A. M., Riches, L., Austin, J., Vijh, R., McGrail, K., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26656990
Beyond direct medical costs: what we miss when indirect costs are ignored
Religioni, U., Barrios‐Rodríguez, R., Requena, P., & Pakulska, T. (2026) · Journal of Medical Economics · doi:10.1080/13696998.2026.2670957
Lee, H., Kang, H., Paik, J.-W., Jeong, Y., Eum, H., & Lee, H. (2026) · Current Medical Research and Opinion · doi:10.1080/03007995.2026.2683436
Economic evaluation of deimplementation interventions: a systematic review
Hountongbé, C. L., Guertin, J. R., Gnanou, S., Conombo, B., Tardif, P., Ivers, N. M., Gandhi, R., & Moore, L. (2026) · BMJ Quality & Safety · doi:10.1136/bmjqs-2025-019895
- Authors
- Duevel, J. A., Hasemann, L., Peña-Longobardo, L. M., Rodríguez-Sánchez, B., Aranda-Reneo, I., Oliva-Moreno, J., López-Bastida, J., & Greiner, W.
- Affiliations
- Bielefeld University (DE)
- University of Castilla-La Mancha (ES)
- Camilo José Cela University (ES)
- ORCID
- Venue
- Health Economics Review
- Published
- 2020-09-22
- Volume
- 10
- Issue
- 1
- Pages
- 32-32
- ISSN
- 2191-1991 (ISSN-L)
- PMC
- PMC7510122
- OpenAlex
- W3088578057
- Cited by
- 34
- References
- 101
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 5
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Health Economics Review (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by-nc-sa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Econstor (Econstor) (submittedVersion, cc-by)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion, cc-by)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Funders
- H2020 European Research Council (779312)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Keywords
- depression, societal perspective, healthcare payer perspective, cost-utility analysis, cost-effectiveness, cost-effectiveness threshold
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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