Reducing the global burden of depression : population level analysis of intervention cost-effectiveness in 14 world regions

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantlyif there is a substantialincrease substantial increase intreatment coverage.

Public internet access revisited

In recent years the Australian government has dedicated considerable project funds to establish public Internet access points in rural and regional communities. Drawing on data from a major Australian study of the social and economic impact of new technologies on rural areas, this paper explores some of the difficulties rural communities have faced in setting up public access points and sustaining them beyond their project funding. Of particular concern is the way that economic sustainability has been positioned as a measure of the success of such ventures. Government funding has been allocated on the basis of these rural public access points becoming economically self-sustaining. This is problematic on a number of counts. It is therefore argued that these public access points should be reconceptualised as essential community infrastructure like schools and libraries, rather than potential economic enterprises. Author Keywords: Author Keywords: Internet; Public access; Sustainability; Digital divide; Rural Australia