Enhanced depression care may be cost-effective for employers
Offering additional depression screening and care may save employers about $3,000 per 1,000 workers over five years, according to a cost-effectiveness and cost-benefit analysis reported in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
In addition to its toll on patients' health and well-being, depression is estimated to cost tens of billions of dollars in the United States each year, according to background information in the article. Most of these costs are associated with reduced productivity at work. Evidence suggests that currently available treatments and screening methods could reduce these costs, but remain underused.
Philip S. Wang, M.D., Dr.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and the National Institute of Mental Health, Bethesda, Md., and colleagues, constructed a computer model to analyze the costs and benefits associated with an enhanced depression care program. The program consisted of screening all employees for depression once and then providing telephone counseling and other depression management strategies for employees with positive results. In the model:
- Hypothetical employees were 40 years old, the median age of U.S. workers
- The workers were divided into six groups—never depressed; depressed but not in treatment; depressed and in treatment; recovered and in treatment; recovered but not in treatment; and dead—based on percentages of each group in the general population
- At the end of each three-month period, the model workers were moved between states based on estimates drawn from previous studies
- Depression treatment could be either adequate or substandard, to reflect realistic quality variations
- The cost of administering the depression screening was based on the cost of adding questions to existing health risk assessments for companies that currently administer them and of implementing new risk assessments for companies that do not
- Treatment and care management costs were based on averages from clinical literature and health plan data
They then completed two analyses of the data—one from a societal perspective, which assigned model employees either to usual care or to the enhanced program and followed them up until death, and another from an employer perspective, a five-year simulation in which the employee base was kept at a constant size by replacing those who left the company or died. In the societal analysis, the enhanced depression management program cost about $19,976 more per quality-adjusted life year than usual care. In other words, for every $19,976 in costs associated with the program, including medication costs and time spent in treatment, one employee would enjoy one additional year without depression because of the intervention. "These results are consistent with recent primary care effectiveness trials and within the range for medical interventions usually covered by employer-sponsored insurance," the authors write.
In the analysis performed from the employer's perspective, after five years the program would save the employer $2,895 per 1,000 workers. These results "may seem counterintuitive at first—namely, that a screening and care management intervention designed to increase the use and intensity of treatment for depression may actually save employers money," the authors write. "However, as our results suggest, the expected higher direct treatment costs are more than offset by savings from reduced absenteeism, presenteeism [when employees are at work, but unproductive] and employee turnover costs."
"If replicated in upcoming effectiveness trials that directly assess intervention effects on work outcomes, these findings suggest that it may be in society's and purchasers' interests to more widely disseminate successful programs of outreach and improved treatment quality for depression," they conclude.
(Arch Gen Psychiatry. 2006;63:1345-1353. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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