Impact of depression on healthcare expenses

DISCLAIMER

Cost finding can be affected by the following:◦ Costing perspective (provider vs societal vs consumer)

◦ Type of therapist (doctoral vs master’s vs professional)

◦ Public or private setting

◦ Duration of intervention

◦ Overhead rate applied

How does this relate to health economics?

PRODUCTIVITY

LARGE MEDICAL EXPENDITURE

RISING MEDICAL EXPENSE

Analysis of...

No Treatment

Costs associated with: Direct

SuicideWorkplace

Large gap in the literature

Pharmacological Treatment

Choice of drug varies by study

Variance in measurement across studies

Cognitive Behavior Therapy

Variance in measurement across studies

Inconsistency of salaries of therapists

No treatment

Direct Costs

1990s ≈ $12 billion2000 ≈ $26 billion

2005 ≈ $77.5 billion2010 ≈ $98.9 billion

Workplace Costs

Presenteeism vs Absenteeism

Equivalent of ≈ 32 incremental workdays lost

Suicide-related Costs

Suicide rate: 14.2 per 100,000 in 200515.9 per 100,000 in 2010

50% attributable to depression

Pharmacological Treatment

Effectiveness

Cost vs Impact on daily life

QALYs

To be determined…

Comparison with…

Cognitive Therapy & No Treatment

Cognitive therapy treatment

Effectiveness

Cost vs Impact on life

QALYs

To be determined…

Compared with…

Medication

Discussion of findings

Pro’s & con’s of review

PRO CON

Research is evolving Comorbidities

Gaps being addressed Inconsistency in literature

Cost of treatment outweighed by savings

Unable to find a standard way to measure QALYs

Every literature review has valley’s and mountains

Wrap Up

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Byford, S. S. Impact of treatment success on health service use and cost in depression: longitudinal database analysis. PharmacoEconomics, 29(2), 157-170. doi:10.2165/11537360-000000000-00000

Cocker, F. F. (2014). Depression in working adults: comparing the costs and health outcomes of working when ill. PloS one, 9(9), e105430. doi:10.1371/journal.pone.0105430

Donohue, J. M. J. M. (2007). Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. PharmacoEconomics, 25(1), 7-24.

Imel, Z. E., Malterer, M. B., McKay, K. M., & Wampold, B. E. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of affective disorders, 110(3), 197-206. doi:http://dx.doi.org/10.1016/j.jad.2008.03.018

Sava, F. A. F. A. Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (Prozac) in treating depression: a randomized clinical trial. Journal of Clinical Psychology, 65(1), 36-52. doi:10.1002/jclp.20550

Serrano-Blanco, A., Gabarron, E., Garcia-Bayo, I., Soler-Vila, M., Carames, E., Penarrubia-Maria, M. T., . . . Depressio en Atencio Primaria de Gava, G. (2006). Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: a six-month randomised study comparing fluoxetine to imipramine. J Affect Disord, 91(2-3), 153-163. doi:10.1016/j.jad.2005.11.014

Wade, A. G. A. G. A review of the costs associated with depression and treatment noncompliance: the potential benefits of online support. International clinical psychopharmacology, 25(5), 288-296.

Watkins, K. E. K. E. The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial. Journal of substance abuse treatment, 46(2), 128-133. doi:10.1016/j.jsat.2013.08.006

Wells, K. B. M. D. M. P. H., Schoenbaum, M. P., Duan, N. P., Miranda, J. P., Tang, L. P., & Sherbourne, C. P. (2007). Cost-Effectiveness of Quality Improvement Programs for Patients With Subthreshold Depression or Depressive Disorder. Psychiatric Services, 58(10), 1269-1278. Retrieved from http://www.library.drexel.edu/cgi-bin/r.cgi/login?url=http://search.proquest.com/docview/213079352?accountid=10559http://ur9ep9bn4s.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQ%3Anursing&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.jtitle=Psychiatric+Services&rft.atitle=Cost-Effectiveness+of+Quality+Improvement+Programs+for+Patients+With+Subthreshold+Depression+or+Depressive+Disorder&rft.au=Wells%2C+Kenneth+B%2C+MD%2C+MPH%3BSchoenbaum%2C+Michael%2C+PhD%3BDuan%2C+Naihua%2C+PhD%3BMiranda%2C+Jeanne%2C+PhD%3BTang%2C+Lingqi%2C+PhD%3BSherbourne%2C+Cathy%2C+PhD&rft.aulast=Wells&rft.aufirst=Kenneth&rft.date=2007-10-01&rft.volume=58&rft.issue=10&rft.spage=1269&rft.isbn=&rft.btitle=&rft.title=Psychiatric+Services&rft.issn=10752730&rft_id=info:doi/