Employer-Sponsored Depression Screening Seen as Saving

BETHESDA, Md., Dec. 4 -- Employers including depression screening with care management as a benefit could help improve workers' lives and the company's bottom line, researchers have concluded.

By screening all employees once and then providing depression management services for those who need it, employers could save about ,000 for every 1,000 workers over five years, reported Philip S. Wang, M.D., Dr.P.H., of the National Institute of Mental Health and Harvard Medical School in Boston, and colleagues.

Although the cost savings, which amount to per worker over five years, might be considered minor from the employer's perspective, such a view overlooks other benefits of such a program, the investigators wrote in the December issue of the Archives of General Psychiatry.

"Analyses from just the employer's perspective miss important improvements beyond increased productivity and job retention, such as positive effects on non-labor outcomes of workers (e.g., diminished suffering, increased marital stability, and decreased needs for caregiver time) and employees' contributions outside the workplace," they wrote.

Dr. Wang and colleagues created a computer model to estimate the costs and benefits of enhanced depression care for workers from the perspectives of societal good and employer/healthcare-purchaser needs.

The model included the following variables:

• Employees were 40 years-old, the median age of the U.S. workforce.
• Workers were divided into five healthcare states, according to population-based percentages: never depressed; depressed but not in treatment; depressed and in treatment; recovered and in treatment; recovered but not in treatment. There was also a group who had died,
• At the end of each three-month period, workers could move between the healthcare states on the basis of estimates drawn from previous studies.
• Therapy for depression could be characterized as either adequate or substandard, to reflect realistic quality variations.
• Costs of administering screening were based on the cost of adding questions to existing health risk assessments for companies that already conducted them, and the costs or initiating such assessment for those that did not.
• The costs of therapy and care management were based on averages from clinical literature and health plan data.

The presumed intervention consisted of a one-time workplace-based depression screen for all employees, and care management for those who test positive for depression. The care management program was assumed to be a telephone-based program using masters-level clinicians (e.g., nurses, medical assistants).

"The generally lower intensity of this depression intervention and the greater feasibility of its implementation may make it more desirable to employers, who are sensitive to resource requirements when purchasing benefits." the authors noted "However, we also assumed lower rates of treatment initiation and treatment adequacy resulting from this intervention vs. more intensive ones."

They defined usual care as "care-seeking and treatment patterns that would occur in the absence of depression screening or care management."

For both the employer-based intervention and usual care, treatment for depression was assumed to consist of visits to a primary care practitioner or psychiatrist and a prescription for a selective serotonin reuptake inhibitor (SSRI).

In the societal analysis, in which the employees would receive usual care or the intervention and would then be followed until their deaths, the intervention was determined to cost ,976 more per quality-adjusted life year (QALY) than standard care.

The results are consistent with those from primary care effectiveness trials, and fall within the range for medical interventions that are usually covered by employer-sponsored insurance, the authors noted.

In the analysis from the employer's perspective, they found that intervention would save ,895 per 1,000 workers over five year.

"Our employer's perspective analyses show results that may seem counterintuitive at first--namely, that a screening and care management intervention designed to increase the use and intensity of treatment for depression may actually save employers money," the authors wrote. "However, as our results suggest, the expected higher direct treatment costs are more than offset by savings from reduced absenteeism, presenteeism, and employee turnover costs."

The investigators noted that the savings from the employer-sponsored intervention could be even greater as more SSRIs come off patent and become available generically.

They acknowledged that the study was limited by a lack of standard methods for estimating the value of lost employee productivity, and the uncertainties of generalizing earlier studies of the effectiveness of primary care interventions to depression.

Despite these limitations, "results from this study suggest that enhanced depression care for workers is cost-beneficial from both the employer's and societal perspectives," they wrote. "If replicated in upcoming effectiveness trials that directly assess intervention effects on work outcomes, these findings suggest that it may be in society's and purchasers' interests to more widely disseminate successful programs of outreach and improved treatment quality for depression."

The study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation. One of the co-authors, Gregory Simon, M.D., has received research grants from Organon and Eli Lilly and Company.