title: The costs and benefits of enhanced depression care to employers.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA. wangphi@mail.nih.gov
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wang
authors.forename: Amanda
authors.initials: A
authors.lastname: Patrick
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Joyce
authors.initials: J
authors.lastname: McCulloch
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
authors.forename: Ronald
authors.initials: R
authors.lastname: Kessler
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000191:economics* / Q000517:prevention & control / Q000628:therapy*; D017049:Employer Health Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics; D008962:Models, Theoretical; D009790:Occupations / Q000191:economics; D010346:Patient Care Management / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D011785:Quality Assurance, Health Care; D019057:Quality-Adjusted Life Years; D012456:Salaries and Fringe Benefits / Q000191:economics / Q000706:statistics & numerical data