Abstract
Background and Objective: A growing body of literature on the economics of depression concludes that this illness has an enormous impact on workplace performance. In addition to work cutback and sporadic absenteeism, the symptoms of depression also result in elevated rates of chronic absenteeism that manifest in the form of workplace disability.
Design and Setting: Using a unique data source that contains the medical, pharmaceutical and disability claims of a national US manufacturer, we measured the extent of disability before and after initial treatment for major depression.
Participants: 1260 employees with at least one medical or disability claim for major depression based on International Classification of Diseases, 9th edition (ICD-9) codes in 1996 or 1997.
Results: We estimate that the decreased disability payments in the first 30 days following initial treatment for major depression results in employer savings totalling $US93 per patient, which can exceed the cost of treatment for a similar period of time. These disability savings do not incorporate several additional sources of likely cost savings to the employer, and thereby underestimate the workplace offsets associated with depression treatment. Additional benefits to the employer from the treatment of depression include reduced work cutback and decreased sporadic absenteeism of treated employees, reductions in some types of medical and prescription drug expenditures following appropriate depression treatment, and productivity improvements by employees serving as caregivers for treated spouses and children. Furthermore, to the extent that new pharmaceutical products offer advantages in the workplace over existing treatments for depression, the first month of such treatment will be associated with workplace savings that exceed per-patient estimates reported here for current treatment modalities.
Conclusions: The findings from this analysis imply that the workplace benefits from improved functioning are substantial and may in fact exceed the usual costs of depression treatment. Thus, purely on economic rather than clinical or quality-of-life grounds, this argues in favour of more aggressive outreach to employees with symptomatic disease that results in initiation of treatment before their symptoms are allowed to persist and result in a disability claim. In this light, detection and treatment of depression in the workplace can be seen as important components of community-based disease management programmes.
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References
Kessler RC, Zhao RC, Katz SJ, et al. Past year use of outpatient services for psychiatric problems in the national comorbidity survey. Am J Psychiatry 1999; 156(1): 115–23
Greenberg PG, Stiglin LE, Finkelstein SN, et al. The economic burden of depression in 1990. J Clin Psychiatry 1993; 45: 405–18
Blazer DG, Kessler RC, McGonagle KA, et al. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 1994; 151(7): 979–86
Kessler RC, Barber C, Birnbaum HG, et al. Depression in the workplace: effects on short-term work disability. Health Affairs 1999 Sep/Oct; 18(5): 163–71
Russell JM, Patterson J, Baker AM. Depression in the workplace epidemiology, economics and effects of treatment. Dis Manage Health Outcomes 1998; 4(3): 135–42
Birnbaum HG, Greenberg PE, Barton M, et al. Workplace burden of depression: case study in social functioning using employer claims data. Drug Benefit Trends 1999 Aug; 11(8): 6–12
Conti DJ, Burton WN. Use of an integrated health data warehouse to measure the employer costs of five chronic disease states. Dis Manage 1999; 1(1): 17–26
Claxton AJ, Chawla AJ, Kennedy S. Absenteeism among employees treated for depression. J Occup Envion Med 1999; 41(7): 605–11
Frank RG, Busch SH, Berndt ER. Measuring prices and quantities of treatment for depression. Am Econ Rev 1998; 88: 106–11
American Psychiatric Association. Practice guidelines for major depressive disorder in adults. Am J Psychiatry 1993; 150(4): 1–26
Russell JM, Berndt ER, Miceli R, et al. Course and cost of treatment for depression with fluoxetine, paroxetine and sertraline. Am J Managed Care 1999 May; 5(5): 597–606
Depression Guideline Panel. Depression in primary care. Vol. 2. Rockville (MD): US Department of Health and Human Services, AHCPR publication 93-0551, 1993
Simon GE, VonKorff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry 1995; 52: 850–6
Finkelstein SN, Berndt ER, Gelenberg A, et al. Functional and symptomatic response during two years of sertraline therapy for chronic depression. Poster presented at the American College of Neuropsychopharmacology, 37th Annual Meetings: 1998 Dec 16; Los Croabas, Puerto Rico
Healy D, McMonagle T. The enhancement of social functioning as a therapeutic principle in the management of depression. J Psychopharmacol 1997; (11): S25–S31
Venditti LN, Arcelus A, Birnbaum H, et al. The impact of antidepressant use on social functioning: reboxetine versus fluoxetine. Int Clin Psychopharmacol. In press About the Authors: Drs Birnbaum and Cremieux, as well as Mr Greenberg, apply econometric and biostatistical methodologies to innovative datasets, including those focusing on workplace costs. Dr Kessler is a leading epidemiologist of psychiatric disorders.
Acknowledgements
This research was supported by an unconditional grant from Pharmacia & Upjohn. The authors would like to thank John Benson for his outstanding research assistance.
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Birnbaum, H.G., Cremieux, P.Y., Greenberg, P.E. et al. Management of Major Depression in the Workplace. Dis-Manage-Health-Outcomes 7, 163–171 (2000). https://doi.org/10.2165/00115677-200007030-00005
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DOI: https://doi.org/10.2165/00115677-200007030-00005