Cost-effectiveness of current and optimal treatment for schizophrenia

Resource allocation for psychosis in Australia

Using a census-based prevalence survey (Jablensky et al, 2000), we estimated the cost of psychosis in urban Australia at AU$2.25 billion (£0.86 billion) per year when valued at prices pertaining in the year 2000 (Carr et al, 2003). About 40% of these costs were spent on direct mental health care, the remainder being the costs of lost productivity (limited to unemployment in our study). The total costs amounted to AU$46 200 (£17 722) per person per year, 20% higher than the average annual male income. The bulk of the treatment cost was accounted for by in-patient care, which appeared to have become the default option in the absence of adequate levels of supported community accommodation. This was indicated by the fact that after ‘non-discretionary’ treatment costs (42% of direct costs) were accounted for (i.e. visits to a general practitioner, medication, crisis or emergency care, acute hospitalisation), almost three-quarters of the remainder was spent on long-stay hospitalisation (Neil et al, 2003). When patterns of community-based service delivery were examined, we found a marked paucity of delivery of psychosocial treatments, rehabilitation and substance use interventions, reflecting the skewing of expenditure towards long-term hospitalisation and away from community care.

Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders

BACKGROUND

Mental health survey data are now being used proactively to decide how the burden of disease might best be reduced.

AIMS

To study the cost-effectiveness of current and optimal treatments for mental disorders and the proportion of burden avertable by each.

METHOD

Data for three affective, four anxiety and two alcohol use disorders and for schizophrenia were compared interms of cost, burden averted and efficiency of current and optimal treatment. We then calculated the burden unavertable given current knowledge. The unit of health gain was a reduction in the years lived with disability (YLDs).

RESULTS

Summing across all disorders, current treatment averted 13% of the burden, at an average cost of 30,000 Australian dollars per YLD gained. Optimal treatment at current coverage could avert 20% of the burden, at an average cost of 18,000 Australian dollars per YLD gained. Optimal treatment at optimal coverage could avert 28% of the burden, at 16,000 Australian dollars per YLD gained. Sixty per cent of the burden of mental disorders was deemed to be unavertable.

CONCLUSIONS

The efficiency of treatment varied more than tenfold across disorders. Although coverage of some of the more efficient treatments should be extended, other factors justify continued use of less-efficient treatments for some disorders.

Premorbid, psychosocial and clinical predictors of the costs of schizophrenia and other psychoses

BACKGROUND

Predictors of the costs of psychosis have received insufficient research attention, particularly factors associated with indirect costs.

AIMS

To identify the predictors of direct mental health care costs and indirect or time-loss costs in psychotic disorders and to discuss their implications for future interventions.

METHOD

Structured interview data from the Low Prevalence Disorders Study (n=980) were used to examine predictors of the costs of psychosis in Australia. Estimates of annual costs per patient were derived from the perspectives of government and society. Hierarchical regressions were used to assess the contributions to costs of premorbid, psychosocial and clinical factors.

RESULTS

Schizophrenia involved greater costs than other psychotic disorders. Non-completion of high-school education and chronicity of illness course were predictive of higher costs across all categories, and some factors were linked primarily with mental health care costs (e.g. age at onset, current symptomatology) or indirect costs (e.g. male gender, overall disability).

CONCLUSIONS

Several concurrent strategies were recommended, including early intervention programmes and assertive evidence-based rehabilitation and supported employment programmes aimed at reducing disability. The cost-effectiveness of these approaches needs to be evaluated from the perspectives of both government and society.

Reducing the burden of affective disorders: is evidence-based health care affordable?

BACKGROUND

Affective disorders remain the leading cause of disability burden despite the availability of efficacious treatment. A wider dissemination of evidence-based health care is likely to impact this burden, however the affordability of such a strategy at the population level is unknown. This study calculated the cost-effectiveness of evidence-based health care for depression, dysthymia and bipolar disorder in the Australian population, and determined whether it was affordable, based on current mental health-related expenditure and outcomes for these disorders.

METHODS

Cost-effectiveness was expressed in costs per years lived with disability (YLDs) averted, a population health summary measure of disability burden. Data from the Australian National Survey of Mental Health and Wellbeing, in conjunction with published randomized trials and direct cost estimates, were used to estimate the 1-year costs and YLDs averted by current health care services, and costs and outcomes for an optimal strategy of evidence-based health care.

RESULTS

Current direct mental health-related health care costs for affective disorders in Australia were 615 million dollars (1997-98 Australian dollars). This treatment averted just under 30,000 YLDs giving a cost-effectiveness ratio of 20,633 dollars per YLD. Outcome could be increased by nearly 50% at similar cost with implementation of an evidence-based package of optimal treatment, halving the cost-effectiveness ratio to 10,737 dollars per YLD.

LIMITATIONS

The method to estimate YLDs averted from the literature requires replication. The costs of implementing evidence-based health care have not been estimated.

CONCLUSIONS

Evidence-based health care for affective disorders should be encouraged on both efficacy and efficiency grounds.