|Benefits to Employers Outweigh Enhanced Depression-Care
It may be in society’s and employers’ best interests to offer
programs that actively seek out and treat depression in the workforce,
suggests an analysis funded by the National Institutes of Health’s
(NIH) National Institute of Mental Health (NIMH). A simulation
based on dozens of studies revealed that providing a minimal level
of enhanced care for employees’ depression* would
result in a cumulative savings to employers of $2,898 per 1,000
workers over 5 years. Even though the intervention would initially
increase use of mental health services, it ultimately would save
employers money, by reducing absenteeism and employee turnover
costs, according to Drs. Philip Wang and Ronald Kessler, of Harvard
University, and colleagues, who report on their findings in the
December 2006 Archives of General Psychiatry.
“Depression exacts economic costs totaling tens of billions of
dollars annually in the United States, mostly from lost work productivity,” noted
Wang. “Yet we’re not making the most of available services and
treatments. Our study calculates what employers’ return on their
investment would be if they purchased enhanced depression treatment
programs for their workers.”
The analysis simulated an enhanced intervention in which master’s-level
health professionals managed the care of a hypothetical group of
40-year-old depressed workers diagnosed with depression. In this
scenario, after assessments had detected the workers’ depression,
the care managers did further assessments and, when necessary,
referred the workers for treatment in this scenario. The researchers
gauged the cost-effectiveness for society and cost-benefit to employers,
using data from existing trials and epidemiological studies, including
the National Co-morbidity Survey Replication, a nationally representative
household survey of 9,282 U.S. adults, conducted in 2001-2003.
The hypothetical workers were assigned to either the enhanced
care or “usual care” — care-seeking and treatment patterns
that would normally occur in the absence of care management. For
both groups, treatment was defined in terms of visits to either
a primary care physician or a psychiatrist who prescribed an antidepressant.
Every three months, the hypothetical workers’ illness status could
change, based on depression prevalence, remission and ongoing treatment
rates, and the probabilities of various outcomes, including increased
risk of death by suicide.
Using results of recent primary care effectiveness trials, the
researchers estimated how successful care managers might be in
helping workers seek out and adhere to adequate treatment regimens.
While the cost-benefit analysis from employers’ perspectives weighed
only monetary factors, quality of life figured into the cost-effectiveness
to society calculation.
Savings from reduced absenteeism and employee turnover and other
benefits of the intervention began to exceed the costs of the program
by the second year, yielding a net savings of $4,633 per 1,000
workers. These savings were somewhat reduced in years 3 through
5, based on conservative assumptions that benefits wane after care
management ceases, while increased use of treatments continues.
The intervention became more expensive than usual care (no workplace
depression management) when there was greater use of psychiatrists
(instead of primary care doctors) or brand-name (instead of generic)
drugs. It also ceased to be cost-saving if employees spent more
than 4 hours of work time in treatment per 3-month cycle. Enhanced
care had the most benefit in cases of higher-level employees who
influenced the productivity of co-workers.
The intervention yielded gains when the simulated costs for care
were consistent with those charged in the real world, suggesting
that providing such programs for workers “appears to be a good
investment of society’s resources,” say the researchers. It will
be important to see if the findings are replicated in effectiveness
trials that directly assess the intervention’s impact on work outcomes,
Also participating in the study were Amanda Patrick, Dr. Jerry
Avorn, Brigham and Women’s Hospital; Dr. Francisca Azocar, Joyce
McCulloch, United Behavioral Health; Dr. Evette Ludman, Dr. Gregory
Simon, Group Health Cooperative.
The research was also supported by the Robert Wood Johnson Foundation.
The National Institute of Mental Health (NIMH) mission is
to reduce the burden of mental and behavioral disorders through
research on mind, brain, and behavior. More information is
available at the NIMH website, http://www.nimh.nih.gov
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.
* Depression http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm