Based on this literature review, one obvious conclusion is that are currently big gaps in the available literature regarding the costs of mood (affective) disorders in Europe. Very few studies reporting cost estimates for the mood (affective) disorders were found. Only three studies were found for bipolar/mania, of which two were from France and one from the UK. Only six studies were found for depression, of which four were from the UK, one from Spain and one from Sweden. In other words, there are more gasp in the available literature than findings. In particular this is true for Central and Eastern Europe (CEE), where no relevant studies were found. One reason for the lack of findings from CEE could admittedly be due to the fact that the search and review has been limited to searches and reviews of studies published in the international literature in English. Additionally, this research project was focused on a search and review of available studies providing evidence of the economic cost of mood (affective) disorders. Based on this, the project search strategy did not include a systematic search of epidemiological studies which may provide data/estimates of treatment and resource use patterns such as medical visits and lost work days (without actually costing these resources). Based on the lack of available data in this review, it is difficult, if not to say impossible, to use the identified data to extrapolate the costs in countries where no studies/data were found. Furthermore, the identified studies differ in design, which makes comparison across studies/countries difficult. One suggestion for future work in this area is to extend the search and review to a broader geographical area (i.e. also include studies from the US in the review). This might not, however, give a tremendeous amount of additional findings for the mood (affective) disorders. This is apparent from two published reviews focused on the costs of mood (affective) disorders. Berto et al. [11] provide a review of the international literature of cost-of-illness studies in depression, and Kleinman et al. [12] provide a recently published review of the costs of bipolar disorder. Both these reviews take a broader geographical approach and include all available literature, which differs from the current review's focus on Europe only. In comparison to the presented findings in the current review only a handful of additional references are identified in these reviews, primarily from the United States. Another suggestion to extend the work already indicated in the discussion above is to combine the search and review results from this work with the results from the epidemiological literature review that has been done in parallel in the EBC project. The combined findings of the health economic and the epidemiological reviews should provide the most comprehensive review of the available evidence regarding mood (affective) disorders in Europe that can be used for cost predictions in countries where there are still gaps in the literature.
