The costs and benefits of enhanced depression care to employers

Arch Gen Psychiatry. 2006 Dec;63(12):1345-53. doi: 10.1001/archpsyc.63.12.1345.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Delivery of Health Care / economics*
  • Delivery of Health Care / statistics & numerical data
  • Depressive Disorder / economics*
  • Depressive Disorder / prevention & control
  • Depressive Disorder / therapy*
  • Employer Health Costs / statistics & numerical data*
  • Health Services Research
  • Hospital Costs / statistics & numerical data
  • Hospitals, Psychiatric / economics
  • Hospitals, Psychiatric / statistics & numerical data
  • Humans
  • Insurance, Health / economics
  • Markov Chains
  • Mass Screening / economics
  • Models, Theoretical*
  • Occupations / economics
  • Patient Care Management / economics
  • Primary Health Care / economics
  • Quality Assurance, Health Care
  • Quality-Adjusted Life Years
  • Salaries and Fringe Benefits / economics
  • Salaries and Fringe Benefits / statistics & numerical data