Do antidepressants reduce the burden imposed by depression on employers?

The ability to perform paid or unpaid work is integral to an individual's quality of life. Therefore, we performed a systematic literature review to examine the impact of depression and its treatment on occupational outcomes. This review found absenteeism from work to be markedly higher among depressed employees and productivity to be dramatically undermined by some symptoms of depression. Gaps in the published literature point to the need for future economic and clinical analyses to include work-related outcomes. Published studies showed that antidepressants can enhance work-related outcomes by alleviating affective symptoms. However, the pharmacological properties of antidepressants may produce differential effects that influence work-related outcomes in other ways. For example, TCAs, but not SSRIs, produce sedation and impair cognitive function in ways that could undermine work-related outcomes. Formal analyses are required to quantify whether the improved social functioning, motivation and vigilance that may be associated with some newer antidepressants translate into improved work-related outcomes. Although few published studies have directly quantified the cost benefit of managing depression and associated lost productivity, existing studies that directly assessed work-related outcomes have suggested that treating depression is cost effective. Gaps in the published literature imply that the impact of depression and antidepressants on occupational outcomes has been understudied. This reflects, in part, the fact that antidepressant studies lasting 4 or 6 weeks are unlikely to capture the impact of treatment on work-related measures. In addition, the current evidence base is fraught with other methodological limitations. The effect of depression on non-paid employment also requires further assessment. In conclusion, the efficacy of antidepressants on work-related outcomes should be measured in clinical trials that have an adequate design and a suitable follow-up period, and included in health technology assessments. Until such studies are available, the evidence base supporting the use of antidepressants will remain incomplete.

Switching asthma patients to a once-daily inhaled steroid improves compliance and reduces healthcare costs.

OBJECTIVE: To determine the costs and consequences of switching asthma patients, managed in primary care, from a twice-daily inhaled corticosteroid (ICS), to either a once-daily or another twice-daily ICS. DESIGN: This was a case-control study based on an interrogation of the General Practice Research Database in the UK, for patients with a Read code of asthma who were managed between 1990 and 2001, and who had received at least two prescriptions for a twice-daily ICS within 12 months, before switching to a once-daily ICS (cases) or another twice-daily ICS (controls). Data on resource use was collected for one year before and after the switch. Patients were stratified according to whether their treatment step had been stepped up, stepped down or remained unchanged. SETTING: A modelling study performed from the perspective of the UK's National Health Service (NHS). MAIN OUTCOME MEASURES: Compliance with ICS, and the cost of drug and non-drug resource use, for the year before and after the switch. RESULTS: Switching patients managed in primary care to a once-daily ICS increased compliance and reduced NHS costs, irrespective of whether patients' treatment had been stepped up or down. Switching patients to another twice-daily ICS increased compliance to a lesser extent, and increased NHS costs. We believe that this paper offers the first documented association between compliance in asthma and NHS management costs. CONCLUSIONS: Compliance and management costs among patients with asthma managed in primary care appear to be related to both changing treatment and dosing regimen. Within the limitations of our study, the results suggest that patients who are switched to a once-daily ICS rather than another twice-daily preparation are better compliers with their ICS medication. Additionally, patients who become high-compliers after being switched to a once-daily ICS incur lower management costs than patients who become high-compliers after being switched to another twice-daily ICS. These findings should now be investigated further under more controlled conditions.