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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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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/