Management of Major Depression in the Workplace: Impact on Employee Work Loss

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.Antidepressants, Cost of illness, Depression, Pharmacoeconomics, Serotonin uptake inhibitors, Tricyclic antidepressants

Using Healthcare Claims Data for Outcomes Research and Pharmacoeconomic Analyses

Healthcare claims data are a practical complement to data from randomised controlled trials (RCTs) for evaluating health outcomes in non-experimental settings and for generalising results to a broader population. Claims data are a relatively inexpensive way to obtain useful information about patient demographics, as well as healthcare resources used for specific medical conditions and procedures from large numbers of patients over extended periods of time. With claims data, it is possible to identify patients who meet specific medical or sociodemographic criteria, estimate their costs, define episodes of medical care, and measure outcomes more globally than is possible with RCT data. Statistical methods exist to address some of the inherent issues with claims data due to their limited clinical detail. We also identify extensions of claims data to productivity issues, the use of centralised claims data such as in Canada, and the application of new statistical methods to outcomes research literature such as sample selection correction methods.Pharmacoeconomics, Outcomes-research, Medical-records, Reimbursement, Cost-analysis