Excess cost of non-remission among outpatients with major depressive disorder

Jong-Min Woo, Hong Jin Jeon, Hyo-Jin Kim, Kwang-Hun Lee, Chang Uk Lee, Jai Sung Noh, Chang Hwa Lee, Jin Pyo Hong, Jong-Min Woo, Hong Jin Jeon, Hyo-Jin Kim, Kwang-Hun Lee, Chang Uk Lee, Jai Sung Noh, Chang Hwa Lee, Jin Pyo Hong

Abstract

Background: The purpose of this study was to assess the economic benefit of achieving remission among outpatients with major depressive disorder (MDD) who are currently employed in Korea.

Methods: Cross-sectional observational study. A total of 337 outpatients with MDD with paid jobs were recruited from 14 psychiatric clinics in Korea and were then divided into three groups as follows: new visit group (n = 128), remitted group (n = 100) and non-remitted group (n = 109). The 17-item Hamilton Depression Rating Scale (HAM-D) was used to decide whether a patient should be assigned to the remitted or non-remitted group. Direct medical and non-medical costs were measured via interview with the subjects. The World Health Organization Health and Work Performance Questionnaire (HPQ) were applied in order to measure the lost productive time (LPT) and related productivity costs.

Results: The three groups did not show a significant difference in direct medical cost. However, the difference between the remitted group and non-remitted group was statistically significant (25.49 ± 52.99 vs. 44.79 ± 126.55, χ (2) = 12.99, p = 0.0015). The remitted group demonstrated a significant improvement in productivity (particularly presenteeism) when compared with the new visit group (Z = -3.29, p = 0.001). Although the non-remitted group received treatment at psychiatric clinics similar to the remitted group, it lost 33 more working hours per month, which is compatible to $332 per month.

Conclusion: These results suggest the economic importance of achieving remission in treating depression.

Keywords: HPQ; Lost productive time; Major depressive disorder; Presenteeism; Remission.

References

    1. Collins JJ, Baase CM, Sharda CE, Ozminkowski RJ, Nicholson S, Billotti GM, Turpin RS, Olson M, Berger ML. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005;47:547–557. doi: 10.1097/01.jom.0000166864.58664.29.
    1. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290:2443–2454. doi: 10.1001/jama.290.18.2443.
    1. Druss BG, Rosenheck RA, Sledge WH. Health and disability costs of depressive illness in a major U.S. corporation. Am J Psychiatry. 2000;157:1274–1278. doi: 10.1176/appi.ajp.157.8.1274.
    1. Woo JM, Kim W, Hwang TY, Frick KD, Choi BH, Seo YJ, Kang EH, Kim SJ, Ham BJ, Lee JS, Park YL. Impact of depression on work productivity and its improvement after outpatient treatment with antidepressants. Value Health. 2011;14:475–482. doi: 10.1016/j.jval.2010.11.006.
    1. Berndt ER, Finkelstein SN, Greenberg PE, Howland RH, Keith A, Rush AJ, Russell J, Keller MB. Workplace performance effects from chronic depression and its treatment. J Health Econ. 1998;17:511–535. doi: 10.1016/S0167-6296(97)00043-X.
    1. Rost K, Smith JL, Dickinson M. The effect of improving primary care depression management on employee absenteeism and productivity A randomized trial. Med Care. 2004;42:1202–1210. doi: 10.1097/00005650-200412000-00007.
    1. Simon GE, Barber C, Birnbaum HG, Frank RG, Greenberg PE, Rose RM, Wang PS, Kessler RC. Depression and work productivity: the comparative costs of treatment versus nontreatment. J Occup Environ Med. 2001;43:2–9. doi: 10.1097/00043764-200101000-00002.
    1. Wang PS, Patrick A, Avorn J, Azocar F, Ludman E, McCulloch J, Simon G, Kessler R. The costs and benefits of enhanced depression care to employers. Arch Gen Psychiatry. 2006;63:1345–1353. doi: 10.1001/archpsyc.63.12.1345.
    1. Brouwer WB, Koopmanschap MA, Rutten FF. Productivity losses without absence: measurement validation and empirical evidence. Health Policy. 1999;48:13–27. doi: 10.1016/S0168-8510(99)00028-7.
    1. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA, Keller MB. Major depressive disorder: A prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord. 1998;50:97–108. doi: 10.1016/S0165-0327(98)00138-4.
    1. Frodl TS, Koutsouleris N, Bottlender R, Born C, Jaeger M, Scupin I, Reiser M, Moeller HJ, Meisenzahl EM. Depression-related variation in brain morphology over 3 years: Effects of stress? Arch Gen Psychiatry. 2008;65:1156–1165. doi: 10.1001/archpsyc.65.10.1156.
    1. Zimmerman M, McGlinchey JB, Posternak MA, Friedman M, Attiullah N, Boerescu D. How should remission from depression be defined? The depressed patient's perspective. Am J Psychiatry. 2006;163:148–150. doi: 10.1176/appi.ajp.163.1.148.
    1. Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:603–613. doi: 10.1001/archpsyc.62.6.603.
    1. Kessler RC, Barber C, Beck A, Berglund P, Cleary PD, McKenas D, Pronk N, Simon G, Stang P, Ustun TB, Wang P. The World Health Organization Health and Work Performance Questionnaire (HPQ) J Occup Environ Med. 2003;45:156–174. doi: 10.1097/01.jom.0000052967.43131.51.
    1. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–296. doi: 10.1111/j.2044-8260.1967.tb00530.x.
    1. Clark D, Salkovskis P, Hackmann A, Middleton H, Anastasiades P, Gelder M. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry. 1994;164:759. doi: 10.1192/bjp.164.6.759.
    1. Wei HT, Chen MH, Huang PC, Bai YM. The association between online gaming, social phobia, and depression: an internet survey. BMC Psychiatry. 2012;12:92. doi: 10.1186/1471-244X-12-92.
    1. Hung CI, Wang SJ, Liu CY. Validation of the Depression and Somatic Symptoms Scale by comparison with the Short Form 36 scale among psychiatric outpatients with major depressive disorder. Depress Anxiety. 2009;26:583–591. doi: 10.1002/da.20464.
    1. Kim KW, Hong JP, Park SJ, Choi JH, Choi HR. Reliability and Validity of Korean Version of Depression and Somatic Symptom Scale(DSSS) Anxiety Mood. 2011;7:9–15.
    1. Park YL, Kim W, Chae JH, Oh KS, Frick KD, Woo JM. Impairment of work productivity in panic disorder patients. J Affect Disord. 2014;157:60–65. doi: 10.1016/j.jad.2013.12.021.
    1. Survey on Labor Conditions by Employment Type []
    1. Sanderson K, Andrews G. Common mental disorders in the workforce: recent findings from descriptive and social epidemiology. Can J Psychiatry. 2006;51:63–75.
    1. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med. 2004;46(4):398–412. doi: 10.1097/.

Source: PubMed

Подписаться