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Benefits to Employers Outweigh Enhanced Depression-Care Costs

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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 issue of the 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, they added.

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.

* Wang PS, Patrick A, Avorn J, Azocar F, Ludman E, McCulloch J, Simon G, Kessler R. The costs and benefits of enhanced depression care to employers. Arch Gen Psychiatry. 2006 Dec;63(12).

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About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): 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. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website .