Troubling connection between expenses for physical illnesses and accessing antidepressant treatment

Approximately one third of work-related productivity losses can be attributed to an employee being either unproductive or unable to function at full capacity because of depression. While recommended use of anti-depressants is associated with increased productivity and decreased disability, depression treatment is often complicated by physical disorders (e.g. heart disease, ulcers, hypertension, and asthma) that also require prescription drug treatment.  A new study led by Dr. Carolyn Dewa, head of the Work and Well-being Research and Evaluation Program, and colleagues points to a troubling connection between out-of-pocket expenses for physical illnesses and accessing antidepressant treatment for depression.

Building on previous research that revealed workers on depression-related short-term disability improved with antidepressant treatment, Dr. Dewa and her team explored if the amount of money spent on medication before a disability episode impacts medication use among workers on depression-related disability.

The team analyzed administrative disability data for approximately 63,000 employees nationwide. The analysis, published in Healthcare Policy Vol.4 No2. 2008, revealed that workers on depression-related short-term disability are more likely to fill a prescription for antidepressant medication if they have previously purchased antidepressants.  This suggests that the medication is viewed as necessary, which may point to increased adherence to antidepressants, an issue that is frequently of concern in depression treatment.

At the same time, a worker on depression-related short-term disability is less likely to fill a prescription for antidepressant medication if the worker already is paying high out-of-pocket costs for medications to treat physical disorders such as heart disease or asthma (about 50 percent of employees studied had a co-morbid chronic physical disorder).  For example, if prior out-of-pocket expenses for medication associated with heart disease were $500, the probability of a worker filling an antidepressant prescription was 40 percent.

This phenomenon may be a barrier to accessing antidepressant treatment, which could delay taking necessary medication, impacting not only a person’s recovery, but also a company’s bottom line.  For example, a delay in use could cost an average of $2,924 extra (based on the average hourly wage of $21.66) per worker on depression-related short-term disability.

As Dr. Dewa explains, these findings highlight the dilemma faced by many employers – the desire to control rising costs of prescription drug benefits must be balanced with the fact that it’s important not to create barriers to treatment.  More research is needed to evaluate if drug benefits should be changed for workers on depression-related disability leave, especially those with a chronic physical condition.

 

 

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