JUBILACI Ó N POR EDAD AVANZADA 6 JUBILACI Ó N POR INCAPACIDAD

A recent trial to prevent secondary depressive episodes collected comprehensive cost data from a sample of individuals with depression (56). The resource uses identified in the control arm were extracted to estimate the costs of depression. The costs from this data (inflated to 2013 prices) were not implemented directly into the SPHR diabetes prevention model as this would have over-

estimated the number of GP visits. The model already accounts for GP attendance due to depression as described in Section 10.1. Therefore, a revised estimate of the cost of depression, excluding GP consultation was estimated using updated unit costs. The resource use estimates and revised unit cost estimates used to generate a cost of depression excluding GP utilisation are reported in Table 51.

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Table 51: Depression utilisation of services and total estimated cost

Assumption for costs Unit cost Source Inflation Annual utilisation

Source Cost per year Practice nurse at surgery GP nurse face to face assume

10 mins

£8.83 (38) 1 2.28 (56) £20.14 Practice nurse at home visit GP nurse face to face assume

30 mins

£26.50 (38) 1 0.03 (56) £0.80 Practice nurse telephone GP nurse face to face assume

10 mins

£8.83 (38) 1 0.17 (56) £1.46 Health visitor Health visitor per hour visit 30

mins

£35.50 (38) 1 0.08 (56) £2.66 District nurse Community nurse 30 mins £24.50 (38) 1 0.02 (56) £0.37 Other nurse GP nurse face to face assume

10 mins

£8.83 (38) 1 0.20 (56) £1.72 HCA phelbotomist Clinical support worker 10

mins

£4.17 (38) 1 0.47 (56) £1.94 Other primary care Advanced nurse with

qualifications

£25.00 (38) 1 0.29 (56) £7.13 Out of hours Inflated of trial costs £22.30 (56) 1.122 0.35 (56) £8.63 NHS direct Inflated of trial costs £21.00 (56) 1.122 0.14 (56) £3.18 Walk-in centre Inflated of trial costs £32.24 (56) 1.122 0.32 (56) £11.39 Prescribed medications Inflated of trial costs £7.98 (56) 1.122 11.61 (56) £103.96 Secondary care Emergency Medicine, Any

Investigation

£109.0 Referen ce costs

1 0.39 (56) £42.51 £205.88

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11

EMPLOYER COSTS

In order to capture wider social benefits of interventions for diabetes prevention, the model was designed to estimate the number of sickness days taken conditional on health status. The model utilises data from a study that estimates productivity loss due to poor health, using days absent from paid employment and normal activities, EQ-5D score, International Classification of Disease (ICD) chapter and socio-demographic data (57). The results can be used to predict the level of productivity loss associated with EQ-5D values and specific disease diagnosis, measured by number of days absent from work. Data was used from a prospective survey of inpatients discharged from a hospital in Wales, United Kingdom from April 2002 to January 2009. The number of days absent from paid employment due to ill health (N=51,326) in the six weeks following discharge was estimated using a zero-inflated negative binomial regression model, which produced large spikes at 0 (zero days off paid employment/normal activities) and 42 days.

The following disease diagnoses were used in the model to estimate the impact of disease on work productivity.

1. Colorectal or breast cancer were associated with ICD group for neoplasms.

2. Diabetes diagnosis was associated with ICD group for Endocrine, nutritional and metabolic diseases.

3. Depression was associated with ICD group for Mental and behavioural disorders.

4. Cardiovascular disease was associated with ICD group for diseases of the circulatory system. The statistical model estimated the number of days absent from work from an employed population. In the SPHR model the number of days absent from work was only applied to individuals in the HSE who reported being in employment and less than 65 years old. The simulated number of days of sick leave was multiplied by 8.67 to scale up the 6 week estimate to the annual cycle of the model. The cost of sick days to the employer was calculated based on a method derived from a previous study of work absenteeism (58). In the SPHR model it is assumed that the employee’s usual salary is not included in the employer cost because the productivity of the replacement worker would generate gains to the employer to compensate for the absent worker. Therefore the employer cost calculation includes excess costs incurred and/or loss of productivity during periods of worker absence. The cost to the employer of work absence due to ill health is based on the number of days of absence, losses due to work not completed, occupational sick pay and the cost of a replacement worker. Productivity losses were estimated based on the friction method, which assumes that there

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are sufficient number of unemployed people within the UK in order to replace workers on sick leave after a given friction period. In this analysis we assumed a friction period of 10 weeks during which the employer incurs a cost due to productivity losses. After the friction period a replacement worker is assumed to be as productive as the employee on sick leave. During the sick leave period there are costs incurred because the employer is obliged to pay statutory sick pay for 28 weeks and many employers also provide occupational sick pay (OSP). In this analysis we assumed that the employee receives full pay for 15 weeks. Within the friction period this payment is subsumed into the

employee’s usual salary, which would have been paid by the employer in the absence of sick leave. However, after the friction period the OSP is included in our estimate of the employer’s cost, because in this period the employer would be paying for the employee on sick leave in addition to a

replacement worker. If the period of absence exceeds 15 weeks (75 days) the employer pays half the salary for a maximum of 16.4 weeks, and no further payments for the remaining period. Table 52 summarises the timing of costs incurred due to periods of absence from work.

The average salary per day is based on a UK national average salary plus national insurance

contributions at this salary (59) . The cost of a replacement worker was calculated in a recent report which estimated the logistical costs of advertising spend for a new employee, the cost of using an agency to recruit for a new employee and the number of days taken for internal HR processes related to a new employee (60). We assume that there are no additional costs to training the replacement worker.

Table 52: Employer cost algorithm for days absent from work due to ill health

Days absence

Productivity lost over friction period

Occupational sick pay Cost replacement worker 1-50 £103.4 per day

51-75 Full pay £103.4 per day Cost of advertising and recruitment temporary worker £5433.

76-157 Half pay £51.7 per day

157-260 None

If an individual of working age dies whilst in employment, the cost of recruiting a replacement worker is included in the calculation of employer costs.

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12

UTILITIES