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Disease Management Programmes for Major Depression: Making the Financial Case

Published online by Cambridge University Press:  12 March 2012

J. Buckle
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Abstract

Depression is a significant burden for the United Kingdom economy and despite conclusive evidence on the clinical efficacy of treatments and acknowledgements of the impact on quality of life, a high proportion still goes undiagnosed and untreated. The purpose of this paper is to present the economic case for a more structured approach to depression management, using techniques from the disciplines of health economics and actuarial science to demonstrate cost-effectiveness and return on investment. The results are presented first as an economic cost-effectiveness analysis, comparing the benefits of additional quality-adjusted life years (QALYs) with the costs, and secondly as a financial projection model of costs and savings, familiar to actuaries.

The results of the model show that from a societal perspective, disease management programmes for depression are likely to both reduce costs and increase quality of life for patients in the overall adult population. This is also true from the perspective of an employer who has the cost burden of direct medical costs and sickness absence. For a healthcare payer who is not bearing the cost of sickness absence, such as a primary care trust (PCT) or private insurer, disease management programmes are likely to improve quality of life, but increase direct healthcare costs. However, the additional cost per QALY is well below the commonly used threshold in the U.K. of £30,000; therefore, most health economists would deem disease management programmes for severe and moderate depression to be a good use of public healthcare funds. The actuarial calculations, which show an internal rate of return for 45% to 50%, validate this conclusion.

Keywords

DepressionDisease ManagementCost-EffectivenessAnalysisActuarial ModellingHealthcare
Type
Sessional meetings: papers and abstracts of discussions
Information
British Actuarial Journal , Volume 15 , Issue 3 , September 2009 , pp. 679 - 725
Copyright
Copyright © Institute and Faculty of Actuaries 2009

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References

Academy Health Issue Brief (2003). Evaluating ROI in state disease management programs. IV(5), available at: http://www.academyhealth.org/Publications/Brieflist.cfm?navItemNumber=54.Google Scholar
Anderson, R.J., Freedland, K.E., Clouse, R.E. & Lustman, P.J. (2001). The prevalence of comorbid depression in adults with diabetes: a meta analysis. Diabetes Care, 24, 1069–1078.CrossRefGoogle ScholarPubMed
Angst, J. (1997). A regular review of the long term follow up of depression. British Medical Journal, 315, 1143–1146.CrossRefGoogle Scholar
Angst, J. (1998). Clinical course of affective disorders. In (Helgason, T.et al., eds.) Depression illness: prediction of course and outcome (1–47). Springer-Verlag, Berlin, Germany.Google Scholar
Badamgarev, E., Weingarten, S.R., Henning, J.M., Knight, K., Hasselblad, V., Anacleto, G. Jnr. & Ofman, J.J. (2003). Effectiveness of disease management programs in depression: a systematic review. American Journal of Psychiatry, 160, 2080–2090.CrossRefGoogle Scholar
Bosmans, J.E., Brook, O.H., Van Hout, H.P.J., De Bruinje, M.C., Nieuwenhuyse, H., Bouter, L.M., Stalman, W.A.B. & Van Tulder, M.W. (2007). Cost-effectiveness of a pharmacy-based coaching programme to improve adherence to anti-depressants. PharmacoEconomics, 25(1), 25–37 (13).CrossRefGoogle Scholar
Callahan, C.M., Hendrie, H.C., Dittus, R.S., Brater, D.C., Hui, S.L. & Tierney, W.M. (1994). Improving treatment of late life depression in primary care: a randomized clinical trial. Journal of the American Geriatric Society, 42, 839–846.CrossRefGoogle ScholarPubMed
D.L., Crippen (2002). Disease management in Medicare: data analysis and benefit design Issues. CBO Testimony, available at: http://www.cbo.giv/ftpdocs/37xx/doc3776/09-19-Medicare.pdf.Google Scholar
Department of Health (2003). Quality and outcomes framework.Google Scholar
Dietrich, A.J., Oxman, T.E., Williams, J.W. Jnr., Schulberg, H.C., Bruce, M.L., Lee, P.W., Barry, S.Raue, P.J., Lefever, J.J., Heo, M., Rost, K., Krœnke, K., Gerrity, M. & Nutting, P.A. (2004). Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. British Medical Journal, 329, 602–609.CrossRefGoogle ScholarPubMed
Disease Management Association of America. Definition of disease management, available at: http://www.dmaa.org/dm_definition.aspGoogle Scholar
Disease Management Workgroup of the American Academy of Actuaries (2007). Draft Disease Management Practice Note.Google Scholar
Gask, L., Dowrick, C., Dixon, C., Sutton, R., Perry, D., Torgerson, D. & Usherwood, T. (2004). A pragmatic cluster randomised controlled trial of an educational intervention for GPs in the assessment and management of depression. Psychological Medicine, 34, 66–72.CrossRefGoogle ScholarPubMed
Gilbody, S., Whitty, P., Grimshaw, J. & Thomas, R. (2003). Educational and organizational Interventions to improve the management of depression in primary care: a systematic review. Journal of the American Medical Association, 289(23), 3145.CrossRefGoogle ScholarPubMed
Gilbody, S., Bower, P. & Whitty, P. (2006). Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations. American Journal of Psychiatry, 189, 297–308.CrossRefGoogle ScholarPubMed
Greenberg, P.E., Stiglin, L.E., Finkelstein, S.N. & Berndt, E.R. (1993). The economic burden of depression in 1990. Journal of Clinical Psychiatry, 54, 405–418.Google ScholarPubMed
Hedrick, S.C., Chaney, E.F., Felker, B., Liu, C., Hassenberg, N., Heagerty, P., Buchanan, P., Bagala, R., Greenberg, D., Paden, G., Fihn, S.D. & Katon, W. (2003). Effectiveness of collaborative care depression treatment in veterans' affairs primary care. Journal of General Internal Medicine, 18, 9–16.CrossRefGoogle ScholarPubMed
Hirschfeld, R.M.A. & Shatzberg, A.F. (1994). Long term management of depression. American Journal of Medicine, 97(S 6A), 33S–38S.CrossRefGoogle ScholarPubMed
Hirschfeld, R. (2001). Clinical Importance of long term antidepressant treatment. British Journal of Psychiatry, 179(42), S4–S8.CrossRefGoogle Scholar
Johnson, A. (2003). Disease management: the programs and the promise. Milliman Research Report.Google Scholar
Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G., Bush, T., Robinson, P. & Russo, J. (1995). Collaborative management to achieve treatment guidelines: impact on depression in primary care. Journal of the American Medical Association, 273, 1036–1031.Google ScholarPubMed
Katon, W., Robinson, P., Von Korff, M., Lin, E., Bush, T., Ludman, E. & Walker, G. (1996). A multifaceted intervention to improve treatment of depression in primary care. Arch. Gen. Psychiatry, 53, 924–932.CrossRefGoogle ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Unützer, J., Simon, G., Walker, E., Ludman, E. & Bush, T. (1997). Population-based care of depression: effective disease management strategies to decrease prevalence. General Hospital Psychiatry, 19, 169–178.CrossRefGoogle ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., Unutzer, J., Bush, T., Russo, J. & Ludman, E. (1999). Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Archives of General Psychiatry, 56, 1109–1115.CrossRefGoogle ScholarPubMed
Katon, W., Rutter, C., Ludman, E., Von Korff, M., Lin, E., Simon, G., Bush, T., Walker, E. & Unutzer, J. (2001). A randomized trial of relapse prevention of depression in primary care. Archives of General Psychiatry, 58, 241–247.CrossRefGoogle ScholarPubMed
Katon, W., Russo, J., Von Korff, M., Lin, E., Simon, G., Bush, T., Ludman, E. & Walker, E. (2002). Long term effects of a collaborative care intervention in persistently depressed primary care patients. Journal of General Internal Medicine, 17, 741–748.CrossRefGoogle ScholarPubMed
Keller, M.B., Lavori, P.W., Mueller, T.I., Endicott, J., Coryell, W., Hirschfeld, R.M.A. & Shea, T. (1992). Time to recovery, chronicity and levels of psychopathology in major depression: a 5 year prospective follow up of 431 subjects. Archives of General Psychiatry, 49, 809–816.CrossRefGoogle ScholarPubMed
Kessler, R.C., Akiskal, H.S., Ames, M., Birnbaum, H., Greenberg, P., Hirschfield, R.M.A., Jin, R., Merikangas, K.R., Simon, G.E. & Wang, P.S. (2006). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry, 163(9), 1561–1568.CrossRefGoogle Scholar
Kirmayer, L.J., Robbins, J.M., Dworkind, M. & Yaffe, M.J. (1993). Somatization and the recognition of depression and anxiety in primary care. Americal Journal of Psychiatry, 150, 734–741.Google ScholarPubMed
Lave, J.R., Frank, R.G., Schulberg, H.C. & Kamlet, M. (1998). Cost-effectiveness of treatments for major depression in primary care practice. Archives of General Psychiatry, 55, 645–651.CrossRefGoogle ScholarPubMed
Liu, C.F., Hedrick, S.C., Chaney, E.F., Heagerty, P., Felker, B., Hasenberg, N., Fihn, S. & Katon, W. (2003). Cost-effectiveness of collaborative care for depression in a primary care veteran population. Psychiatric Services, 54, 698–704.CrossRefGoogle Scholar
Mirkin, D.P., Zenner, P.A. & Parke, R. (2004). Insight into two analytical challenges for disease management. Milliman Research Report.Google Scholar
National Pharmaceutical Council (2003). Disease management for depression, available at: http://www.ncpnow.org/Research.aspx.Google Scholar
Nice Guideline on Depression (2004). www.nice.org.uk/CG023NICEGuidelinesGoogle Scholar
Piccinelli, M. & Wilkinson, G. (1994). Outcome of depression in psychiatric settings. British Journal of Psychiatry, 164, 297–304.CrossRefGoogle ScholarPubMed
Pignone, M.P., Gaynes, B.N., Rushton, J.L., Burchell, C.M., Mulrow, C.D., Orleans, C.T & Lohr, K.N. (2002). Screening for depression in adults: a summary of the evidence for the US preventive services taskforce. Annals of Internal Medicine, 13, 765–776.CrossRefGoogle Scholar
Pyne, J.M., Rost, K.M., Zhang, M., Williams, D.K., Smith, J. & Fortney, J. (2003). Cost-effectiveness of a primary care depression intervention. Journal of General Internal Medicine, 18, 432–441.CrossRefGoogle ScholarPubMed
Rost, K., Nutting, P., Smith, J.L., Elliot, C.E. & Dickinson, M. (2002). Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. British Medical Journal, 325, 934.CrossRefGoogle ScholarPubMed
Schœlnbaum, M., Unützer, J., Sherbourne, C., Duan, N., Rubenstein, L.V., Miranda, J.Meredith, L.S., Carney, M.F. & Wells, K. (2001). Cost-effectiveness of practice-Initiated quality improvement for depression: results of a randomized controlled trial. Journal of the American Medical Association, 286, 1325–1330.CrossRefGoogle Scholar
Secta & Nice (2004). Costing clinical guidelines: depression.Google Scholar
Simon, G.E., Revicki, D., Heiligenstein, J., Grothaus, L., Von Korff, M., Katon, W. & Hylan, T.R. (2000a). Recovery from depression, work productivity, and healthcare costs among primary care patients. General Hospital Psychiatry, 22, 153–162.CrossRefGoogle ScholarPubMed
Simon, G.E., Von Korff, M., Rutter, C. & Wagner, E. (2000b). Randomized trial of monitoring, feedback and management of care by telephone to improve treatment of depression in primary care. British Medical Journal, 320, 550–554.CrossRefGoogle ScholarPubMed
Simon, G.E., Katon, W., Von Korff, M., Unützer, J., Lin, E., Walker, E.A., Bush, T., Rutter, C. & Ludman, E. (2001). Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. American Journal of Psychiatry, 158, 1638–1644.CrossRefGoogle ScholarPubMed
Simon, G.E., Von Korff, M., Ludman, E.J., Katon, W., Rutter, C., Unutzer, J., Lin, E.H., Bush, T. & Walker, E. (2002). Cost-effectiveness of a program to prevent depression relapse in primary care. Medicare Care, 40, 941–950.CrossRefGoogle ScholarPubMed
Simon, G.E., Ludman, E.J., Tutty, S., Operskalski, B. & Von Korff, M. (2004). Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized trial. Journal of the American Medical Association, 292, 935–942.CrossRefGoogle Scholar
Simon, G.E., Katon, W.J., Lin, E.H., Rutter, C., Manning, W.G., Von Korff, M., Ciechanowski, P., Ludman, E.J. & Young, B.A. (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry, 64, 65–72.CrossRefGoogle ScholarPubMed
Sobocki, P., Jönsson, B., Angst, J. & Rehnberg, C. (2006). Cost of depression in Europe. Mental Health Policy Economics, 9(2), 87–98.Google ScholarPubMed
Sobocki, P., Ekman, M., Ågren, H., Krakau, I., Runeson, B., Mårtensson, B. & Jönsson, B. (2007). Health-related quality of life measured with EQ-5D in patients treated for depression in primary care. Value Health, 10(2), 153–160.CrossRefGoogle ScholarPubMed
Stewart, W.F., Ricci, J.A., Chee, E., Hahn, S.R. & Morganstein, D. (2003). Cost of lost productive work time among US workers with depression. Journal of the American Medical Association, 289(23), 3135–3144.CrossRefGoogle ScholarPubMed
Sturm, R. & Wells, K.B. (1998). Improving the quality and cost-effectiveness of treatment for depression. Rand Health, 4500–1.Google Scholar
Thompson, C., Kinmoth, A.L., Stevens, L., Ostler, K.J., Pickering, R.M., Baker, N.G., Henson, A., Preece, J., Cooper, D. & Campbell, M.J. (2000). Effects of a clinical practice guidelines and practice based education on detection and outcome of depressive in primary care: Hampshire depression project randomised controlled trial. The Lancet, 355, 185–191.CrossRefGoogle ScholarPubMed
Von Korff, M., Gruman, J., Schæfer, J., Curry, S. & Wagner, E. (1997). Collaborative management of chronic illness. Annals of Internal Medicine, 127(12), 1097–1102.CrossRefGoogle ScholarPubMed
Von Korff, M., Katon, W., Bush, T., Lin, E.H.B., Simon, G.E., Saunders, K., Ludman, E., Walker, E. & Unützer, J. (1998). Treatment costs, cost offset and cost-effectiveness of collaborative management of depression. Psychosomatic Medicine, 60, 143–149.CrossRefGoogle ScholarPubMed
Wang, P.S., Berglund, P. & Kessler, R.C. (2000). Recent care of common mental disorders in the US: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15, 284–292.CrossRefGoogle Scholar
Wells, K., Sherbourne, C., Schœnbaum, M., Duan, N., Meredith, L., Unützer, J., Miranda, J., Carney, M.F. & Rubenstein, L.V. (2000). Impact of disseminating quality improvement programs for depression in managed primary care: a randomized clinical trial. Journal of the American Medical Association, 283, 212–220.CrossRefGoogle Scholar
Williams, A. (1985). The value of QALYs. Health and Social Services Journal, 3.Google Scholar
Wooster, E. (2008). While we are waiting: experiences of waiting for and receiving psychological therapies on the NHS. We Need to Talk Campaign.Google Scholar
Worrall, G., Angel, J., Chaulk, P., Clarke, C. & Robbins, M. (1999). Effectiveness of an educational strategy to improve family physicians' detection and management of depression: a randomized controlled trial. Canadian Medical Association, 161, 37–40.Google ScholarPubMed
Young, A.S., Klap, R., Sherbourne, C.D. & Wells, K.B. (2001). The quality of care for depressive and anxiety disorders in the US. Archives of General Psychiatry, 58, 55–61.CrossRefGoogle Scholar