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The Costs and Benefits of Enhanced Depression Care to Employers
Philip S. Wang, MD, DrPH;
Amanda Patrick, MS;
Jerry Avorn, MD;
Francisca Azocar, PhD;
Evette Ludman, PhD;
Joyce McCulloch, MS;
Gregory Simon, MD, MPH;
Ronald Kessler, PhD
Arch Gen Psychiatry. 2006;63:1345-1353.
Context Although outreach and enhanced treatment interventions improve depression outcomes, uptake has been poor in part because purchasers lack information on their return on investment.
Objective To estimate the costs and benefits of enhanced depression care for workers from the societal and employer-purchaser perspectives.
Design Cost-effectiveness and cost-benefit analyses using state-transition Markov models. Simulated movements between health states were based on probabilities drawn from the clinical literature.
Participants Hypothetical cohort of 40-year-old workers.
Intervention Enhanced depression care consisting of a depression screen and care management for those depressed vs usual care.
Main Outcome Measures Our base-case cost-effectiveness analysis was from the societal perspective; costs and quality-adjusted life-years were used to compute the incremental cost-effectiveness of the intervention relative to usual care. A secondary cost-benefit analysis from the employer's perspective tracked monetary costs and monetary benefits accruing to employers during a 5-year time horizon.
Results From the societal perspective, screening and depression care management for workers result in an incremental cost-effectiveness ratio of $19 976 per quality-adjusted life-year relative to usual care. These results are consistent with recent primary care effectiveness trials and within the range for medical interventions usually covered by employer-sponsored insurance. From the employer's perspective, enhanced depression care yields a net cumulative benefit of $2895 after 5 years. In 1-way and probabilistic sensitivity analyses, these findings were robust to a variety of assumptions.
Conclusion If these results can be replicated in effectiveness trials directly assessing effects on work outcomes, they suggest that enhanced treatment quality programs for depression are cost-beneficial to purchasers.
Author Affiliations: Department of Psychiatry (Dr Wang) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (Drs Wang and Avorn and Ms Patrick), Brigham and Women's Hospital, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston (Drs Wang and Kessler); United Behavioral Health, San Francisco, Calif (Dr Azocar and Ms McCulloch); Center for Health Studies, Group Health Cooperative, Seattle, Wash (Drs Ludman and Simon); and National Institute of Mental Health, Bethesda, Md (Dr Wang).
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