The economic value of depression treatment in the Netherlands

Background: The value of our mental health is reflected in the resources that we invest in mental health care. The spending on treatment for mental disorders is €15,9 billion per year. Most studies suggest that the indirect costs of mental disorders (because of an increase in sick days and a reduction in productivity) are significantly higher. Problem statement: Almost a billion Euro per year is spend on depression treatment in the Netherlands, but there is a lack of insight in the actual economic benefits of treatment. While studies have shown that certain treatments are cost-effective and lead to better work outcomes, it is not known what the beneficial effects of depression treatment are on a national level. Measuring the benefits of depression treatment is difficult because there is a lack of information on the economic effects of depression when no treatment takes place. Therefore it is not known what effects are due to treatment en what effects are part of the natural course of depression. Research question: What are the economic effects of depression treatment in a work context? Methods: A combination of a Delphi method en the System-Cost Effectiveness model is applied. Professionals whom have sufficient experience with employees with depression and its treatment function as respondents. They receive information on findings in other studies and are asked to estimate the effects of depression treatment on absenteeism and presenteeism (productivity) in the Netherlands. The independent variable is whether or not there is adequate treatment. Dependent variables are the number of sick days and productivity. Furthermore, respondents are asked to estimate the distribution of depression severity and the rate of adequate treatment. They estimate these effects based on experience within their own patient population. N=37. Results: There is no significant effect of depression treatment on the number of sick days. There is a significant positive relationship between depression treatment and productivity. Furthermore a significant effect is found between depression severity and the rate of adequate treatment. Discussion: The lack of a significant effect between treatment and the number of sick days can be caused by national regulation that protects the employee, practitioners who feel that absence of work is beneficial, methodological issues (including a low number of respondents) or employees with the lowest amount of sick days who do not have contact with respondents. The positive relationship between adequate treatment and productivity was expected. Most of the national economic benefits are yielded through increased productivity. In total this accumulates up to €436 million in economic benefits per year under conservative assumptions. The rate of adequate treatment varies between 50,7% (mild) and 77,6% (severe) depending on depression severity. The more severe the depression, the more likely it was that the employee would receive adequate treatment (p<0.05). Main limitation is uncertainness on validity and reliability of the data. Further studies are required to strengthen confidence in any conclusions. Conclusion: The two main accomplishments in this thesis are the development of a method to differentiate between the effects of adequate treatment compared to no (adequate) treatment, and arriving at a concrete number for the current economic benefits of depression treatment. (€436 million). Furthermore, the reasons for the large portion of inadequate treatment should be explored. If all employees would receive adequate treatment, the benefits of depression treatment would rise to €653 million annually. A final recommendation that was mentioned repeatedly by respondents is that the focus on work resumption within treatment should be stronger. It is worth mentioning that the current economic benefit of €436 million is based on a limited group. It cannot be directly compared to the costs of direct treatment (€966 million). It is promising that the economic benefit within this limited area of work and depression is already responsible for such a large recuperation of the spending on treatment for depression.