• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (35)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Medical Practice  • Health Policy  • Psychiatry  • Depression  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Investing in mental health and well-being: findings from the DataPrev project
Mcdaid and Park
HEALTH PROMOT INT 2011;26:i108-i139.
ABSTRACT | FULL TEXT  

Severity of Depression and Magnitude of Productivity Loss
Beck et al.
Ann Fam Med 2011;9:305-311.
ABSTRACT | FULL TEXT  

Work and common psychiatric disorders
Henderson et al.
JRSM 2011;104:198-207.
ABSTRACT | FULL TEXT  

Persisting Decline in Depression Treatment After FDA Warnings
Libby et al.
Arch Gen Psychiatry 2009;66:633-639.
ABSTRACT | FULL TEXT  

Improving Mental Health Treatments Through Comparative Effectiveness Research
Wang et al.
Health Aff (Millwood) 2009;28:783-791.
ABSTRACT | FULL TEXT  

Depression and Cardiovascular Health Care Costs Among Women With Suspected Myocardial Ischemia: Prospective Results From the WISE (Women's Ischemia Syndrome Evaluation) Study
Rutledge et al.
J Am Coll Cardiol 2009;53:176-183.
ABSTRACT | FULL TEXT  

Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care
Baker et al.
Psychological Science in the Public Interest 2008;9:67-103.
ABSTRACT | FULL TEXT  

Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial
Wang et al.
JAMA 2007;298:1401-1411.
ABSTRACT | FULL TEXT