Rajendra Kadel Personal Social Service Research Unit London School of Economics, UK 16/10/2015

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- To explore available economic evidence on workplace-

initiated interventions for employees with common mental disorders.

- To evaluate cost-effectiveness of workplace interventions for employees with common mental disorders to improve mental wellbeing and work productivity.

Objectives

Systematic review of work-initiated interventions for employees with common mental disorders

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Eligibility Criteria

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• Population: Currently working population (18-64 years)

• Intervention: Workplace-initiated interventions for common mental disorders (anxiety and depression) and stress disorders

• Outcomes: clinical (reduction in symptoms – stress levels, anxiety and depression scores), QALY, Productivity (absenteeism and Presenteeism), disability limitation, work functioning

• Study design: CT, RCT, Quasi-experimental, evaluation studies, economic modelling

• Economic analysis: CEA, CBA, CCA, CMA.

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• 10434 hits

• 12 studies and 7 study protocols met inclusion criteria.

• Most economic studies were conducted alongside RCTs.

• 5 studies were with high methodological quality and remaining were with moderate (2) to low quality (5).

• There was no consistency in the reporting of outcome measures.

(Note: >75= high; 75-51=medium; ≤50=low)

Results

Results………………….. • 9 studies assessed cost-effectiveness, 1 study cost benefit and

2 studies cost-consequences analyses.

• 5 studies showed that interventions were cost effective, four studies were less cost-effective compared to control, 3 studies demonstrated that interventions were cost savings.

• Interventions were effective on reducing lost productivity and sickness absenteeism.

• Interventions yielded mixed effect on clinical and quality related outcome measures (2 studies: control was more effective, 1 study: productivity increased, but less effective in reducing disability leave).

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Results Interventions Effective Cost-effective CB ROI C Sav Collaborative MH Care Vs OP (1)

QoL -N ICER: €14,589/QALY

- - -

E-mental health and OP Vs no further step (2)

E-mental: work functioning –N OP: WF - Y

E-mental: €4054 OP: dominant

- - -

SHARP-at work (problem solving intervention) Vs no training to OPs (3)

Reduce sickness absence -Y

98% probability of cost-effective at WTP €70

NMB: €5530

- -

Computerised CBT Vs Att. Control (4)

PHQ, GAD -Y - - - £79/Pt

Work and health initiative by EAP counsellor Vs OP (5)

20-40% perfm., product- 3.5% improve & 7.1% reduce absence

- - - $6041.70 saving

Care with OPs + refer to RTW coordinator Vs OP (6)

Lasting RTW - Y QALY gain -N

ICER: €627 per one day reduction in sick leave

NMB- €6243

- -

Activating counselling by OP Vs access to Psychiatrist (7)

Productivity -Y ICER: €106/day decrease on sick leave

NMB: €1.17 per emp.

- -

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Results…………

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Interventions Effective CE CB ROI C Sav Recreational music making Vs no RMM - 6 wks (8)

46% improvement in burnout, 18% reduce in staff turnover

- - $60 per $

$8,100 100 bed hospt.

Collaborative mental health programme Vs no CMHP (9)

Higher RTW Short disability leave

Less costly than control

- - $503/ employee

Emotion-focused stress reduction intervention Vs wait-list control (10)

Productivity, motivation -Y

- - - $1,179 per employee

Work-based (11) enhanced depression care, then CBT 6 wks Vs CAU

Reduction in absenteeism and presenteeism

- - - £80.75/ person

Training to GPs and care managers on EDC Vs usual GP care (12)

Self-reported productivity and absenteeism - Y

- NMB–yr 1: $30/Case & Yr 2: $257

302% -

Gaps • Limited economic studies on workplace interventions for

employees experiencing or at risk of CMDs

• No economic evaluations so far regarding managers’ training on mental health and its impact on employees mental health and productivity

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Conclusions • Workplace interventions for employees with CMDs can

be cost-effective, can yield considerable ROI for employers

• More research is needed

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Thank you

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8. Bittman B, Bruhn KT, Stevens C, Westengard J, Umbach PO. Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers. Advances in Mind Body Medicine. 2003;19(3/4):4-15.

9. Dewa CS, Hoch JS, Carmen G, Guscott R, Anderson C. Cost, Effectiveness, and Cost-Effectiveness of a Collaborative Mental Health Care Program for People Receiving Short-Term Disability Benefits for Psychiatric Disorders. CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE. 2009;54(6):379-88.

10. McCraty R, Atkinson M, Lipsenthal L, Arguelles L. New Hope for Correctional Officers: An Innovative Program for Reducing Stress and Health Risks. Appl Psychophysiol Biofeedback. 2009;34(4):251-72.

11. Knapp M, McDaid D, Parsonage M. Mental health promotion and mental illness prevention: the economic case. London: 2011.

12. Wang PS, Patrick A, Avorn J, Azocar F, Ludman E, McCulloch J, et al. The costs and benefits of enhanced depression care to employers. Archives of General Psychiatry. 2006;63(12):1345.

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