Cost‐Effectiveness of Depression Screening for Otolaryngology–Head and Neck Surgery Residents

Abstract

Objectives This study aims to determine the cost‐effectiveness of screening and treating otolaryngology–head and neck surgery residents for depression. Methods A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost‐effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5‐year period, was performed to evaluate both base case values and a range of values for model variables. Results Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost‐effective and the optimal strategy at a willingness‐to‐pay threshold of $50 thousand per quality‐adjusted life year (QALY). This option demonstrated an incremental cost‐effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost‐effective options in 94.9% of simulations. Conclusion Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost‐effective. Based on these results, residency programs may consider trialing standardized depression screening protocols. Level of Evidence I and II. Laryngoscope, 131:502–508, 2021

Assessment of Sleep Features, Mental Health Outcomes, and Alcohol and Tobacco Consumption in Residents and Fellows in Otolaryngology Before and During the COVID-19 Pandemic

“…2,9,10 Residents and fellows in surgical disciplines, such as otolaryngology-head and neck surgery, are particularly at risk regarding demanding, unpredictable workload, highstakes surgeries, and nights on call. 2,11 In this cohort study, we observed significant rates of depression and sleep disorders in residents and fellows, which have increased throughout the pandemic period. Regarding US studies, the prevalence of depression ranged from 5% to 28% of residents in otolaryngology-head and neck surgery, 3,12 with a 15% increase in depressive symptoms after the start of residency.…”

“…Pandemics may be associated with negative outcomes in the workload, stress, sleep and mental health status of health care workers . Residents and fellows in surgical disciplines, such as otolaryngology–head and neck surgery, are particularly at risk regarding demanding, unpredictable workload, high-stakes surgeries, and nights on call …”

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

“…Of the 25 included articles, only 1 aimed to determine cost-effectiveness of an intervention to improve well-being. 55 However, cost-effectiveness was not considered from the institutional (ie, the health system within which residents work) perspective. Specifically, the authors used incremental cost-effectiveness ratios to compare the cost of various interventions that would be incurred by the institution (ie, through paying for resident's health insurance) relative to the resident's expected clinical outcome (ie, quality-adjusted life years 58 ) of each intervention.…”

“…Of the 25 articles reviewed, 1 (4%) article 55 had an aim that is directly related to our research question in that it set out to determine the cost-effectiveness of screening and treating for depression (a critical detractor from well-being); however, cost-effectiveness was not considered from the institutional perspective. Aims of the other 24 (96%) articles were related to factors that impact well-being (eg, burnout, stress) or workplace sequelae of poor well-being (eg, attrition), but not economics of these elements.…”

“…Inextricable from this discussion is the role residents play in organizational economics, central to which is the complex balance between education and service 21. Although residents are by definition learners in the midst of their specialty training, their skill set allows them to overlap in some duties with higher-paid staff, which is highly cost-effective for the institutions they serve given their low salaries, long hours worked, and external supplemental funding for health care institutions that support Graduate Medical Education 22–27. As a result, there is often no incentive for redundancy in staffing and a historical reliance of health care delivery systems on residents for normal operations 28.…”