Short-term Disability Benefits Research Articles

Out-of-Pocket Spending and Work Loss after Common Surgical Procedures Among Working-Age Adults

INTRODUCTION: Half of surgical patients report financial toxicity, which results from direct out-of-pocket (OOP) cost and indirect loss of income. This study aimed to assess the economic impact of common surgical procedures on patient OOP spending and work loss among working-age adults. METHODS: We used the 2017 to 2019 MarketScan Database to identify adults ages 19 to 64 years who underwent 1 of 20 common surgical procedures. These data were linked to the Health Productivity and Management (HPM) Database, which reports work absence and disability for a subset of employers. Outcomes included spending after index operation, disability, and return to work. Multivariable regression models adjusted for patient demographics and clinical variables. To control for secular trends, we used 4:1 propensity score matching using patient and employment variables. RESULTS: We identified 135,480 patients and 541,920 matched controls. Among this cohort, 25% of patients had a nonelective presentation and 12% had an ICU admission. Spending, missed work, and disability for patients linked to the HPM database are shown in the Table. Nonelective presentation was associated with higher OOP spending and more short-term disability (p < 0.05). Patients requiring ICU stay had higher OOP spending and more missed days of work and disability (p < 0.05). Table. - Six Month Out-of-Pocket Spending and Missed Work after Common Surgical Procedures Variable Surgical patients Matched controls Difference p Value Mean OOP spending (median, IQR) $3,487 ($2,020, $749-3,597) $636 ($12, $0-422) $2,851 <0.001 Any missed work 62.1% 32.5% 29.6% <0.001 Mean total days missed (median, IQR) 23 (15,4-36) 3 (2, 0-4) 20 <0.001 Any short-term disability 36.2% 2.7% 33.5% <0.001 Mean total days of short-term disability (median, SD) 41 (32, 19-56) 35 (15, 0-54) 6 <0.001 Surgical cohorts include common cardiac, vascular, general, and orthopedic procedures. OOP spending represents coinsurance, copays, and deductibles per patient. Missed work and short-term disability outcomes are only for those linked to the HPM database and employed at time of index admission. CONCLUSION: Patients recovering from operation face high OOP payments, miss over a month of work on average, and one in three receive short-term disability benefits. These findings demonstrate the double burden of medical expense and productivity loss and can inform policies for improved financial risk protection after operation.

The direct and indirect costs of adult atopic dermatitis.

BACKGROUND: Atopic dermatitis is considered a childhood illness, and the direct and indirect health care burden of atopic dermatitis in adults is not fully understood. OBJECTIVE: To measure the direct and indirect costs of atopic dermatitis among adults in 2018. METHODS: This retrospective cohort study compared commercial and Medicare-insured adults with atopic dermatitis in 2018 with directly matched (1:3) adults without atopic dermatitis. Atopic dermatitis prevalence was reported. Health care utilization, direct health care costs, and work loss data were compared between cohorts. This analysis was repeated for adults with atopic dermatitis in 2016 and 2017. RESULTS: 31,164 adults with atopic dermatitis in 2018 were identified and directly matched (1:3) to controls. Adults with atopic dermatitis had greater utilization of outpatient services, outpatient pharmacy services, and short-term disability benefits than controls. Unadjusted annual health care costs in 2018 were $4,979 higher for adults with atopic dermatitis ($14,603) than for the matched controls ($9,624), driven by outpatient services and pharmacy. Findings were supported by analyses of adults from 2016 and 2017 and multivariable analyses. One limitation of this study was that patients with mild cases of atopic dermatitis may not seek medical treatment and may be underrepresented in the study cohort. CONCLUSIONS: The direct health care and indirect (short-term disability) health care costs of atopic dermatitis present a significant health care burden among the adult population. DISCLOSURES: This study was funded by Eli Lilly and Company. Employees of Eli Lilly were involved in the planning, execution, and interpretation of the study. Pierce is employed by Eli Lilly and Company. Boytsov and Goldblum were employed by Eli Lilly and Company Health at the time this research was conducted. Manjelievskaia and Brouillette are employed by IBM Watson Health, which received funding from Eli Lilly and Company to conduct this study. Bonafede and Onyekwere were employed at IBM Watson Health at the time this research was conducted.

Work absenteeism and disability associated with psoriasis and psoriatic arthritis in the USA\u2014a retrospective study of claims data from 2009 TO 2020

ObjectivesTo compare work absenteeism and short-term disability among adults with psoriasis or psoriatic arthritis (PsA), versus controls in the USA. MethodsAdults eligible for work absenteeism and/or short-term disability benefits between 1/1/2009 and 4/30/2020 were screened in the IBM® MarketScan® Commercial and Health and Productivity Management Databases. The following groups were defined: (1) psoriasis: ≥ 2 psoriasis diagnoses ≥ 30 days apart and no PsA diagnoses; (2) PsA: ≥ 2 PsA diagnoses ≥ 30 days apart; (3) control: absence of psoriasis and PsA diagnoses. Controls were matched to psoriasis and PsA patients based on age, gender, index year, and comorbidities. Non-recreational work absences and sick leaves were evaluated in absentee-eligible patients, and short-term disability was evaluated in short-term disability-eligible patients. Costs (in 2019 USD) associated with each type of work absence were evaluated.Results4261 psoriasis and 616 PsA absentee-eligible and 25,213 psoriasis and 3480 PsA short-term disability-eligible patients were matched to controls. Average non-recreational work absence costs were $1681, $1657, and $1217 for the PsA, psoriasis, and control group, respectively. Compared with psoriasis patients and controls, more PsA patients had sick leaves after 1 year (56.2% versus 55.6% and 41.5%, p < 0.0001). Similarly, short-term disability was more frequent in PsA patients than psoriasis patients and controls at year one (8.8% versus 5.6% and 4.7%, p < 0.0001) and corresponding costs were higher ($605, $406, and $335 on average, p < 0.0001).ConclusionAnnual work absenteeism and short-term disability were consistently greater among patients with PsA and psoriasis than controls, highlighting the substantial economic burden of psoriatic disease.Key points• Patients with PsA had greater short-term disability compared with patients with psoriasis and patients with neither psoriasis nor PsA.• Patients with PsA and patients with psoriasis incurred greater non-recreational work absences and sick leaves than patients with neither psoriasis nor PsA.

Statistical Inference for Periodic Self-Exciting Threshold Integer-Valued Autoregressive Processes.

This paper considers the periodic self-exciting threshold integer-valued autoregressive processes under a weaker condition in which the second moment is finite instead of the innovation distribution being given. The basic statistical properties of the model are discussed, the quasi-likelihood inference of the parameters is investigated, and the asymptotic behaviors of the estimators are obtained. Threshold estimates based on quasi-likelihood and least squares methods are given. Simulation studies evidence that the quasi-likelihood methods perform well with realistic sample sizes and may be superior to least squares and maximum likelihood methods. The practical application of the processes is illustrated by a time series dataset concerning the monthly counts of claimants collecting short-term disability benefits from the Workers’ Compensation Board (WCB). In addition, the forecasting problem of this dataset is addressed.

Increased Healthcare Resource Utilization and Direct and Indirect Costs in Patients with Depression and Comorbid Overactive Bladder: Evidence From a Retrospective, Matched Case-Control Cohort Analysis.

IntroductionThis study sought to compare healthcare resource utilization (HCRU), costs, and workplace productivity among patients with depression, with and without overactive bladder (OAB).MethodsThis retrospective, case–control cohort analysis compares HCRU, costs, and workplace productivity among propensity score matched patients with depression and OAB (case cohort) and patients with depression without OAB (control cohort). Patients were aged 18 years or older, insured/on Medicare, and had diagnosed depression and an antidepressant medication claim pre index. First OAB-related event was index for cases; controls were assigned a proxy (study period 12 months). Comparisons of HCRU and costs and regression models assessed the relationship between OAB and costs. For the workplace productivity subset analyses cases and controls were balanced on baseline covariates for the short-term disability analyses but as they were unbalanced for the absentee analyses, multivariate regression analyses were used for this subset.ResultsThe study criteria were met by 39,085 cases and 308,736 controls, from which, 37,997 patients were successfully matched 1:1 (mean age 55 years; 81% female). Most depression-related HCRU measures were similar across cohorts; however, outpatient visits, ER visits, and number of unique depression medications were significantly higher (all p < 0.05) among cases. Cases also had 13% higher total depression-related costs (p < 0.0001). Total mean (standard deviation [SD]) depression-related costs were $1796 ($4235) for cases versus $1597 ($3863) for controls (p < 0.0001). For workplace productivity (absentee data: cases [n = 686], controls [n = 642]; short-term disability data: cases [n = 4395], controls [n = 4433]) absentee outcomes were similar across cohorts. However, a higher percentage of cases used short-term disability benefits compared to controls (21.3% versus 16.9%; p < 0.0001) and cases experienced more case days (11.0 versus 8.6 mean days) and received higher mean payments than controls ($1226 versus $1033; p < 0.0001) in this subset.ConclusionsOAB was associated with 13% higher depression-related costs and 4.4% more cases used short-term disability benefits.Electronic Supplementary MaterialThe online version of this article (10.1007/s12325-020-01485-w) contains supplementary material, which is available to authorized users.

An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study.

BackgroundAnxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations.ObjectiveThe aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among individuals involved with 2 insurance companies. The 2 samples were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic.MethodsIndividuals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months.ResultsAll samples showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77; anxiety d=1.13; and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other samples, experienced significant moderate effects at posttreatment (depression d=0.58; anxiety d=0.54; and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC samples were significantly smaller than in the PF sample who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF sample who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF samples on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF sample with no disability benefits d=0.90) and those on short-term disability benefits d=0.94).ConclusionsMany clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small sample sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described.

Effectiveness and cost-effectiveness of interferon beta and glatiramer acetate in the UK Multiple Sclerosis Risk Sharing Scheme at 6 years: a clinical cohort study with natural history comparator

In 2002, the UK's National Institute for Clinical Excellence (NICE) concluded that interferon beta and glatiramer acetate would be cost effective as disease-modifying therapies (DMTs) for multiple sclerosis only if the short-term disability benefits reported in clinical trials were maintained. The UK Multiple Sclerosis Risk Sharing Scheme (RSS) was established to assess whether disability progression was consistent with a cost-effectiveness target of £36 000 per quality-adjusted life-year projected over 20 years. We aimed to evaluate the long-term effectiveness and cost-effectiveness of these DMTs by comparing a cohort of patients with relapsing-remitting multiple sclerosis enrolled in the UK RSS with a natural history cohort from British Columbia, Canada. In our clinical cohort we included patients starting a DMT who were enrolled in the UK RSS who had relapsing multiple sclerosis at baseline and had at least one further clinical assessment. In our control cohort we included patients in the British Columbia multiple sclerosis database (BCMS; data collection 1980-96) who met the same eligibility criteria as for the RSS cohort. We compared disability progression at 6 years for RSS patients with untreated progression modelled from BCMS patients using continuous Markov and multilevel models. The primary outcomes were the progression ratio (treated vs untreated) measured both in Expanded Disability Status Scale (EDSS) score and utility. A ratio of less than 100% for EDSS implied slower than expected progression on treatment compared with off treatment; a utility ratio of 62% or less implied that the DMTs were cost effective. 5610 patients starting a DMT were enrolled in the UK RSS between Jan 14, 2002, and July 13, 2005 (72 sites), of whom 4137 were included in our clinical cohort. We included 898 BCMS patients in the control cohort who met the RSS inclusion criteria and had at least one EDSS score after baseline. RSS patients had a mean follow-up of 5·1 years (SD 1·4). Both models showed slower EDSS progression than predicted for untreated controls (Markov model, 75·8% [95% CI 71·4-80·2]; multilevel model, 60·0% [56·6-63·4]). Utility ratios were consistent with cost-effectiveness (Markov model, 58·5% [95% CI 54·2-62·8]; multilevel model, 57·1% [53·0-61·2]). Findings from this large observational study of treatment with interferon beta or glatiramer acetate provide evidence that their effects on disability in patients with relapsing-remitting multiple sclerosis are maintained and cost effective over 6 years. Similar modelling approaches could be applied to other chronic diseases for which long-term controlled trials are not feasible. Health Departments of England, Wales, Scotland, and Northern Ireland, Biogen Idec, Merck Serono, Bayer Schering Pharmaceuticals, Teva Pharmaceuticals Industries, UK National Institute of Health Research's Health Technology Assessment Programme.

Short-term disability in solid tumor patients with bone metastases and skeletal-related events

Objective:The skeleton is a common site of metastasis in patients with solid tumors. These patients often experience pain and reduced quality-of-life. This analysis evaluated the time and costs associated with short-term disability use among solid tumor patients with bone metastases (BM) and skeletal-related events (SREs).Methods:Data from patients 18–64 years old with solid tumors and BM, eligible for short-term disability benefits between January 1, 2002 and December 31, 2010, were extracted from MarketScan Research Databases. Short-term disability hours and costs associated with BM and SREs were evaluated.Results:Overall, 1098 patients met the criteria. For all patients with BM, the monthly mean short-term disability hours were 17.7 h pre-BM diagnosis and increased to 60.2 h post-BM diagnosis (p < 0.001). The corresponding mean monthly short-term disability costs were $277 and $963 in the pre- and post-BM diagnosis periods, respectively (p < 0.001). Monthly mean short-term disability hours were higher for the cohort of patients with SREs (21.2 h pre-SRE diagnosis and 67.4 h post-SRE diagnosis) than for those without an SRE (8.6 h pre-SRE diagnosis and 14.4 h post-SRE diagnosis) (p < 0.001). Similarly, the corresponding monthly mean short-term disability costs were higher for patients with SREs ($625 and $1259 pre- and post-SRE diagnosis, respectively) than for patients without an SRE ($452 and $612 pre- and post-SRE diagnosis, respectively) (p < 0.001). Results of a multivariate analysis indicated that SREs were associated with an additional 39.4 short-term disability hours and $613 in short-term disability costs per month (p < 0.001).>Conclusion:Short-term disability hours and costs increased significantly when patients with solid tumors developed BM and SRE.

Abstract 13352: Work Absenteeism, Short Term Disability and Related Indirect Costs Associated with Cardiovascular Events and Related Clinical Procedures

Objectives: To examine work absenteeism (WA) and short-term disability (STD) hours and related indirect costs associated with cardiovascular events and related procedures (CVERP): myocardial infarction (MI), ischemic stroke (IS), unstable angina (UA), heart failure (HF), transient ischemic attack (TIA), coronary artery bypass graft (CABG), and percutaneous coronary intervention (PCI). Methods: Full-time employees aged 18-64, with WA or STD benefits, hyperlipidemia or lipid-lowering therapy, and ≥1 CVERP in 2003-2011 were extracted from a large claims and productivity database. Index date was the date of the first CVERP. All patients had data for ≥1 year pre-index and ≥1 month post-index. Per patient per month (PPPM) WA and STD hours were measured during the acute 1 month and 1 year post-index periods. Indirect costs associated with these hours were calculated using the Bureau of Labor Statistics wage rates (in 2013 $). Results: A total of 5,803 patients were included in the WA analysis (mean age 53, 86% male, mean Charlson comorbidity index [CCI] 0.6) and 21,074 in the STD analysis (mean age 53, 82% male, mean CCI 0.7). Patients with CABG as the first CVERP type had the highest mean PPPM costs and hours during the acute 1 month and the 1 year post-index periods (Fig. 1), followed by MI (for WA acute 1 month and 1 year, for STD acute 1 month) and HF (for STD 1 year). Mean PPPM WA hours ranged between 31 - 61 (indirect cost: $998 - $1842) and STD hours between 31- 121 (indirect cost: $532 - $2154) during the acute 1 month post-index period. Compared with the mean PPPM hours lost from work in the pre-index period, mean PPPM WA hours went up by 22.5 hours (indirect cost by $647) in the acute 1 month post-index period, and STD went up by 53 hours ($916). Conclusions: CVERP were associated with substantial work loss and related indirect costs, especially in the acute first month period following CVERP. Prevention of CVERP could result in potential WA and STD related cost savings for employers.

Advantages of the Net Benefit Regression Framework for Economic Evaluations of Interventions in the Workplace

Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known. To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations. Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges. Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

Depression in the workforce: the intermediary effect of medical comorbidity

Background It is amply documented that mood disorders adversely affect job satisfaction, workforce productivity, and absenteeism/presenteeism. It is also well documented that mood disorders are an independent risk factor for several chronic medical disorders (e.g., obesity, diabetes mellitus, cardiovascular disease). Emerging evidence indicates that the workforce dysfunction associated with depression is partially mediated by medical comorbidity. Methods We conducted a PubMed search of all English-language articles published between 2005 and July 2009 with the following search terms;;; major depressive disorder and depression, cross-referenced with work productivity, disability, economic cost, absenteeism, presenteeism, and medical comorbidity. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality. Results Mood disorders are the most impairing condition amongst working adults. It is estimated that approximately 35-50% of employees with depression will take short-term disability leave at some point during their job tenure. Moreover, 15-20% of the workforce will receive short-term disability benefits during any given year; the annual income of individuals affected by depression is reduced by approximately 10% when compared to unaffected employees. Chronic stress-sensitive conditions independently contribute to workforce maladjustment and associated disability. The mood disorder population is differentially affected by several stress-related medical conditions resulting in greater impairment in the workforce. Conclusion Disability modelling in the depressed employee has emphasized the complex interrelationship between depressive symptoms, workforce stress, and consequent disability. A more refined model must include the effects of chronic medical conditions as a powerful mediator and/or moderator of workforce impairment. Multidisciplinary interventions have been demonstrated to reduce, but not eliminate workforce disability related to depression, underscoring the need for elucidating other modifiable factors. Screening, treatment, and prevention initiatives need to target chronic medical conditions in depressed employees in order to reduce overall workforce disability.

Cost, Effectiveness, and Cost-Effectiveness of a Collaborative Mental Health Care Program for People Receiving Short-Term Disability Benefits for Psychiatric Disorders

Cost, Effectiveness, and Cost-Effectiveness of a Collaborative Mental Health Care Program for People Receiving Short-Term Disability Benefits for Psychiatric Disorders

Erratum

Carolyn S Dewa, Jeffrey S Hoch, Glenn Carmen, et al. Cost, effectiveness, and cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. Can J Psychiatry. 2009;54(6):379–388. The authors have found a spelling error in one author's last name. The error appears on page A3 and on page 379. The author's last name was incorrectly spelt as Gusscott; the correct spelling is Guscott. The Canadian Journal of Psychiatry regrets the error and any inconvenience it might have caused.

Cost, Effectiveness, and Cost-Effectiveness of a Collaborative Mental Health Care Program for People Receiving Short-Term Disability Benefits for Psychiatric Disorders

To examine the cost, effectiveness, and cost-effectiveness of a collaborative mental health care (CMHC) pilot program for people on short-term disability leave for psychiatric disorders. Using a quasi-experimental design, the analyses were conducted using 2 groups of subjects who received short-term disability benefits for psychiatric disorders. One group (n = 75) was treated in a CMHC program during their disability episode. The comparison group (n = 51) received short-term disability benefits related to psychiatric disorders in the prior year but did not receive CMHC during their disability episode. People in both groups met screening criteria for the CMHC program. Differences in cost and days absent from work were tested using Student t tests and confirmed using nonparametric Wilcoxon rank sum tests. Differences in return to work and transition to long-term disability leave were tested using chi-square tests. The cost-effectiveness analysis used the net benefit regression framework. The results suggest that with CMHC, for every 100 people on short-term disability leave for psychiatric disorders, there could be $50 000 in savings related to disability benefits along with more people returning to work (n = 23), less people transitioning to long-term disability leave (n = 24), and 1600 more workdays. CMHC models of disability management based on our Canadian data may be a worthwhile investment in helping people who are receiving short-term disability benefits for psychiatric disorders to receive adequate treatment.

Previous Out-of-Pocket Drug Expenditures and Patterns of Antidepressant Use among Workers Receiving Depression-Related Disability Benefits

This study explored the effects of out-of-pocket expenditures on antidepressant use among workers receiving depression-related short-term disability benefits. The authors examine the association between workers' out-of-pocket expenditures prior to their disability episode and their use, or delay in use, of antidepressants during the episode. The results indicate that higher out-of-pocket expenditures for antidepressants prior to the disability episode were associated with higher odds of using an antidepressant during the episode. However, results also suggested that higher out-of-pocket expenditures for other prescriptions were associated with significantly lower odds of an antidepressant claim during the episode. Greater prior out-of-pocket expenditures for other prescription drugs may serve as a barrier to accessing antidepressant treatment. Workers receiving short-term disability benefits who have previously purchased prescriptions for other conditions may be more sensitive to out-of-pocket expenditures for antidepressant prescriptions.

The Impact of Rheumatoid Arthritis on Medical Expenditures, Absenteeism, and Short-Term Disability Benefits

The objectives of this study were to estimate medical expenditures, absenteeism, and short-term disability costs for workers with rheumatoid arthritis (RA) and to estimate the relative costs of RA over a 12-month period. Using data from nine U.S. employers, direct and indirect costs for 8502 workers with RA were compared with costs for a matched group without RA. Regression analyses controlled for factors that were different even after propensity score matching. Average total costs for workers with RA were $4244 (2003 dollars) greater than for workers without RA. RA was the fourth most costly chronic condition per employee compared with cancers, asthma, bipolar disorder, chronic obstructive pulmonary disease, depression, diabetes, heart disease, hypertension, low back disorders, and renal failure. RA is a costly disorder and merits consideration as interventions are considered to improve workers' health and productivity.

Disability Focus Could Improve Outcomes, Insurer Believes

Back to table of contents Previous article Next article Health Care EconomicsFull AccessDisability Focus Could Improve Outcomes, Insurer BelievesKate MulliganKate MulliganSearch for more papers by this authorPublished Online:21 May 2004https://doi.org/10.1176/pn.39.10.0012Top officials at CIGNA Corporation speculated that the integration of disability and health care programs might be the “missing link” that employers seek “when it comes to total benefits cost control, productivity gains, meeting the workforce’s evolving benefits needs, and providing administrative simplicity.”In “Disability and HealthCare Connection: How Strong Is the Link?,” W. Allen Schaffer, M.D., chief medical officer at CIGNA HealthCare, and Barton Margoshes, M.D., chief medical officer at CIGNA Group Insurance, reported on analysis of data from 156 client companies that offer CIGNA short-term disability benefits (STD) and CIGNA HealthCare as a core medical option. Those companies’ employees could select among medical providers.Out of the 60,000 STD claims that were filed within those 156 companies in the study period of 2001-2003, approximately 13,000 were filed by employees who had selected CIGNA Healthcare, and 47,000 were filed by employees who had selected another carrier.The authors found that more than half (56 percent) of STD-related medical costs were attributable to employees with chronic health issues, such as heart disease and diabetes.However, those chronic conditions accounted for only about one-quarter (26 percent) of medical episodes. (A medical episode is a group of claims related to a single medical event, such as a broken leg.)In other words, chronic conditions were approximately twice as expensive to employers as episodic conditions.Steven Pflanz, M.D., told Psychiatric News that the data support other studies that have found “a small percentage of employees with significant illness use a disproportionate share of medical resources.”Pflanz is chair of APA’s Corresponding Committee on Psychiatry in the Workplace.Medical costs related to the average short-term disability dwarfed the cost of the STD payments alone.The study found, on average, that the total direct disability and medical costs of an STD is $13,094. Of this total, $10,649 was attributable to medical costs, while only $2,444 was associated with STD benefit payments.The authors noted that STD medical costs often continue after the employee returns to work.Pflanz commented that it is clear that disability payments are just “the tip of the iceberg” when calculating the costs to an employer of a disabled employee.Schaffer and Margoshes wrote, “It is not uncommon for an individual to have ‘shadow’ costs of mental health, which result when they become depressed from another condition like lower back problems or diabetes and need to be out of work.”They reported that for patients in disease-management programs, depression is prevalent among 37 percent of those with low back pain, 11 percent of those with asthma, and 7 percent of those with cardiac disease and diabetes.Depression is a secondary factor in other disabilities almost half the time, according to the study.CIGNA officials recommend that health and disability professionals take a “more holistic view” of disability and recognize the likelihood of depression or other mental health factors as a hurdle in overcoming the disability.In CIGNA client companies that have both STD and medical benefits, an employee with a disability is connected quickly by the disability nurse case manager to a mental health counselor, if the employee agrees.The authors concluded that “disability and health care results can no longer be viewed in silos—they truly are linked.”They contrast an “old paradigm” in which the disability event was considered to start when an employee filed a disability claim and ended when the employee returned to work with a “new paradigm.”In the new paradigm, disability must be managed in phases: “before it occurs, through prevention; during the disability, to actively assist the employee back to work; and after the employee has returned to work, to ensure the employee has the support necessary to prevent recurrence of disability.”According to the report, CIGNA is the only health benefits company with its own pharmacy, behavioral, dental, vision, and disability businesses, “so the company is able to provide industry-leading services that treat ‘the whole person.’ ”The study, “Disability and Healthcare Connection: How Strong Is the Link?,” is posted online at www.cigna.com/health/producer/newsletter/mar2004/pdf/Disability_Healthcare.pdf. ▪ ISSUES NewArchived

Pattern of antidepressant use and duration of depression-related absence from work.

Few studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits. To address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability? An observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996-1998 were linked for workers receiving depression-related short-term disability benefits during that time. Recommended first-line agents and recommended doses were significantly associated with return to work (chi(2)=6.64, P<0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (beta=-24.1; 95% CI -34.4 to -13.8). Depression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

Pattern of antidepressant use and duration of depression-related absence from work

BackgroundFew studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits.AimsTo address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability?MethodAn observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996–1998 were linked for workers receiving depression-related short-term disability benefits during that time.ResultsRecommended first-line agents and recommended doses were significantly associated with return to work (χ2=6.64, P &lt; 0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (β=-24.1; 95% CI-34.4 to −13.8).ConclusionsDepression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

Use of antidepressants among Canadian workers receiving depression-related short-term disability benefits.

Little is known about how antidepressants are being used, but rising antidepressant expenditures and the accompanying impulse to control costs make this a critical issue to be addressed. The authors studied patterns of antidepressant use in a population of workers receiving depression-related short-term disability benefits to determine whether populations likely to benefit from antidepressants are using them and, if so, whether they are using them in a way that the benefits from their use are maximized. The analyses were based on 1996-1998 administrative data from short-term disability and prescription drug benefit claims and occupational health department records for employees of three Canadian companies. Approximately 58 percent of employees who were receiving depression-related short-term disability benefits had made at least one antidepressant claim. Employees who did not use antidepressants typically reported significantly fewer symptoms at baseline on average than those who did. About 91 percent of the employees who used antidepressants filled at least one prescription for a guideline-recommended first-line agent. Approximately 79 percent of antidepressant dosages reflected those suggested by the Canadian Network for Mood and Anxiety Treatment, and three timeframe indicators suggested that most patients used antidepressants within the recommended timeframes. The results of this study represent an important first step in exploring the question of how antidepressants are used among workers with depression-related disability. For the most part, these workers and those whose depression was more severe were more likely to obtain antidepressants.