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Arch Gen Psychiatry. 2006 Dec;63(12):1345-53.

The costs and benefits of enhanced depression care to employers.

Author information

  • 1Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA. wangphi@mail.nih.gov

Abstract

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.

PMID:
17146009
[PubMed - indexed for MEDLINE]
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