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. ©2006 American Medical Association. All rights reserved.
CITATION STYLE
Wang, P. S., Patrick, A., Avorn, J., Azocar, F., Ludman, E., McCulloch, J., … Kessler, R. (2006). The costs and benefits of enhanced depression care to employers. Archives of General Psychiatry, 63(12), 1345–1353. https://doi.org/10.1001/archpsyc.63.12.1345
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