Journal of Mental Health Policy and Economics最新文献

{"title":"Reduction in Costs after Treating Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder.","authors":"Vedrana Ikic,&nbsp;Claude Belanger,&nbsp;Stephane Bouchard,&nbsp;Patrick Gosselin,&nbsp;Frederic Langlois,&nbsp;Joane Labrecque,&nbsp;Michel J Dugas,&nbsp;Andre Marchand","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction.</p><p><strong>Aims of the study: </strong>The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD).</p><p><strong>Methods: </strong>A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups.</p><p><strong>Results: </strong>At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CADUSD 2,000.48 (SD = USD 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up.</p><p><strong>Discussion: </strong>Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity.</p><p><strong>Implications for healthcare provision and use: </strong>Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society.</p><p><strong>Implications for health policies: </strong>Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders.</p><p><strong>Implications for further research: </strong>In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"11-20"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34921774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Willingness to Pay in Caregivers of Patients Affected by Schizophrenia.","authors":"Claudiane Salles Daltio,&nbsp;Cecilia Attux,&nbsp;Marcos Bosi Ferraz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is a debilitating disorder that often requires the affected individual to receive care from a caregiver. Willingness to Pay (WTP) technique allows a valuation of the health state preferences by assessing the impact of the disease and translating it into monetary terms.</p><p><strong>Aims of the study: </strong>The objective was to determine the WTP of schizophrenic patients' caregivers on a hypothetical recovery scenario and correlate it to socio-demographic and clinical characteristics, Knowledge of Disease, Quality of life and Burden of Disease.</p><p><strong>Methods: </strong>A convenience sample consecutively assessed 189 outpatients' caregivers from Schizophrenia Program of Federal University of Sao Paulo. A single caregiver was considered for each patient, taking into consideration their close relationship and their direct involvement in the treatment. Open WTP questionnaire for a hypothetical schizophrenia recovery scenario, KAST (Knowledge of Disease), SF-6D (Quality of life) and ZBI-22 (Burden of Disease) scales were applied.</p><p><strong>Results: </strong>A monthly WTP mean value (SD) of USUSD 63.63 (111.88) was found. The average value (SD) found was 12.96 (2.45) on KAST, 0.78 (0.08) on SF6D and 29.91 (16.10) on ZARIT. Income, education, social class, knowledge of disease and burden of caregiver were positively correlated to the WTP value. By linear regression model, income and education remained significant.</p><p><strong>Conclusion: </strong>Willingness to Pay (WTP) is a method that can be used to determine the strength of preference of patients and caregivers for a recovery in schizophrenia. The higher the income and education, the higher the willingness to pay. No clinical characteristics of patients had a statistically significant relation to the value the caregiver would pay.</p><p><strong>Implications for health policies: </strong>WTP is a potentially useful tool to determine values and health care preferences, and can be used for the development of mental health policies.</p><p><strong>Implications for further research: </strong>Future research should be used to enhance WTP tool in mental health studies on the impact of diseases, including schizophrenia.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"3-10"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34920794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVES: Accountability for Mental Health: The Australian Experience.","authors":"Sebastian Rosenberg,&nbsp;Luis Salvador-Carulla","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Australia was one of the first countries to develop a national policy for mental health. A persistent characteristic of all these policies has been their reference to the importance of accountability. What does this mean exactly and have we achieved it? Can Australia tell if anybody is getting better?</p><p><strong>Aims of the study: </strong>To review accountability for mental health in Australia and question whether two decades of Australian rhetoric around accountability for mental health has been fulfilled.</p><p><strong>Methods: </strong>This paper first considers the concept of accountability and its application to mental health. We then draw on existing literature, reports, and empirical data from national and state governments to illustrate historical and current approaches to accountability for mental health. We provide a content analysis of the most current set of national indicators. The paper also briefly considers some relevant international processes to compare Australia's progress in establishing accountability for mental health.</p><p><strong>Results: </strong>Australia's federated system of government permits competing approaches to accountability, with multiple and overlapping data sets. A clear national approach to accountability for mental health has failed to emerge. Existing data focuses on administrative and health service indicators, failing to reflect broader social factors which reveal quality of life. In spite of twenty years of investment and effort Australia has been described as outcome blind, unable to demonstrate the merit of USD 8bn spent on mental health annually.</p><p><strong>Discussion and limitations: </strong>While it may be prolific, existing administrative data provide little outcomes information against which Australia can genuinely assess the health and welfare of people with a mental illness. International efforts are evolving slowly.</p><p><strong>Implications for health care provision and use: </strong>Even in high income countries such as Australia, resources for mental health services are constrained. Countries cannot afford to continue to invest in services or programs that fail to demonstrate good outcomes for people with a mental illness or are not value for money.</p><p><strong>Implications for health policies: </strong>New approaches are needed which ensure that chosen accountability indicators reflect national health and social priorities. Such priorities must be meaningful to a range of stakeholders and the community about the state of mental health. They must drive an agenda of continuous improvement relevant to those most affected by mental disorders. These approaches should be operable in emerging international contexts.</p><p><strong>Implications for further research: </strong>Australia must further develop its approach to health accountability in relation to mental health. A limited set of new preferred national mental health indicators should be agreed. T","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"37-54"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34921777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and Effectiveness of Treating Homeless Persons with Cocaine Addiction with Alternative Contingency Management Strategies.","authors":"Stephen T Mennemeyer,&nbsp;Joseph E Schumacher,&nbsp;Jesse B Milby,&nbsp;Dennis Wallace","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Between 1990 and 2006 in Birmingham, Alabama USA, 4 separate randomized controlled studies, called \"Homeless 1\" through \"Homeless 4\", treated cocaine substance abuse among chronically homeless adults, largely black men, many with non-psychotic mental health problems. The 4 studies had 9 treatment arms that used various counseling methods plus, in some arms, the provision of housing and work therapy usually with a contingent requirement of urine-test verified abstinence from substances. Participants in the abstinent-contingent arms who lapsed on abstinence were removed from housing and sent to an evening public shelter from which they were daily transported to day treatment until they returned to abstinence.</p><p><strong>Aims of the study: </strong>This paper compares the cost effectiveness of the treatment arms.</p><p><strong>Methods: </strong>Societal cost per participant (in 2014 dollars) for each arm is defined as direct treatment cost plus cost of jail or hospital plus societal expense of public shelter use by lapsed participants. An untreated Base Case is defined as 5 percent abstinence with 95 percent usage of a public shelter. Incremental Cost Effectiveness Ratios (ICERs) for paired arms are defined as the change in cost per participant divided by the change in abstinence. Bootstrapping estimates confidence intervals.</p><p><strong>Results: </strong>Average cost per participant at the end of 6 months of active treatment in 7 arms with comparable data ranged from USD 10,447 to USD 36,194 with corresponding average weeks abstinent ranging from 6.1 to 15.3 out of a possible 26 weeks. In contrast, the Base Case would cost USD 6,123 for 1.3 weeks of abstinence. Compared to the Base Case, the least expensive \"DT2\" treatment has an ICER of USD 901 (95% CI = USD 571 to USD 1,681) per additional week of abstinence and the most expensive \"CMP4\" has an ICER of USD 2,147 (95% CI = USD 1,701 to USD 2,848). Additionally, the Homeless 3 study found that the abstinent contingent housing (ACH3) treatment compared to the Non Abstinent Contingent Housing (NAC3), analogous to \"Housing First\", achieved better abstinence (12.1 v. 10 weeks) at higher average cost (USD 22,512 v. USD 17,541) yielding an ICER for this comparison of (USD 2,367, 95% CI=USD -10,587 to USD 12,467). Similar results are found at 12 months (6 months after active treatment).</p><p><strong>Discussion: </strong>More intensive methods of counseling improved abstinence but 4 of the 7 treatments were inefficient (\"dominated\"). Bootstrapping shows that results are sensitive to which individuals were randomly assigned to each arm. A limitation of the analysis is that it does not consider the full societal cost of lost wages, crime costs beyond jail expenses and deterioration of neighborhood quality of life. Additionally, populations treated by Housing First programs may differ from the Birmingham Homeless studies in the severity of addiction or co-occuring psychol","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"21-36"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34921775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Got Munchies? Estimating the Relationship between Marijuana Use and Body Mass Index.","authors":"Isabelle C Beulaygue,&nbsp;Michael T French","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Although marijuana use is commonly associated with increased appetite and the likelihood of weight gain, research findings in this area are mixed. Most studies, however, report cross-sectional associations and rarely control for such important predictors as physical activity, socioeconomic status, and alcohol and other drug use.</p><p><strong>Methods: </strong>Using data from Waves III (N = 13,038) and IV (N = 13,972) of the National Longitudinal Survey of Adolescent Health, we estimate fixed-effects models to more rigorously study the relationships between marijuana use and body mass index over time. Our analyses include numerous sensitivity tests using alternative estimation techniques and at Wave IV we investigate the relationship between marijuana use and an alternative measure of body size (waist circumference).</p><p><strong>Results: </strong>Results show that daily female marijuana users have a BMI that is approximately 3.1% (p<0.01) lower than that of non-users, whereas daily male users have a BMI that is approximately 2.7% (p<0.01) lower than that of non-users.</p><p><strong>Discussion: </strong>The present study indicates a negative association between marijuana use and BMI. Uncovering a negative association between marijuana use and weight status is a valuable contribution to the literature, as this result contradicts those from some previous studies, which were unable to address time-invariant unobserved heterogeneity.</p><p><strong>Implications for future research: </strong>Future theory-based research is necessary to explore the metabolic and behavioral pathways underlying the negative associations between marijuana use and BMI. A broader understanding of such mechanisms along with causal estimates will be most helpful to both policymakers and clinicians.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 3","pages":"123-40"},"PeriodicalIF":1.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34344566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Right to Refuse Medication Laws and Procedures: Impact on Homicide and Suicide.","authors":"Griffin Edwards","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>As part of the expansive overhaul of the mental health system that occurred in the latter half of the 20th Century, many states passed laws that allow, under certain conditions, voluntary and involuntarily committed patients to refuse medication. While some predicted the consequences of these laws would be dire, the effect on violent behavior remains untested.</p><p><strong>Aims of the study: </strong>The aim is to decipher any differences state right to refuse medication laws may have on violence.</p><p><strong>Method: </strong>Using the homicide rate of every US state between 1972 and 2001 (N = 1,479), and the suicide rate between 1981 and 2001 (N = 1,071). The study compares the difference in homicide/suicide rates before and after a law change to that same difference in a set of control states to estimate the effect of laws aimed at extending the right to refuse medication to both voluntary and involuntarily committed mental health patients.</p><p><strong>Results: </strong>Laws designed to allow voluntarily committed patients to refuse medication are associated with a 0.8 increase in homicides per 100,000 of the state population while laws dictating an involuntarily committed patient's right to request refusal of medication are negative but statistically insignificant using standard t test. Laws designed to allow voluntarily committed patients to refuse medication have no statistically significant effect on suicides while laws dictating an involuntarily committed patient's right to request refusal of medication, specifically when the request is reviewed by independent mental health professionals, are associated with a statistically significant reduction in suicides.</p><p><strong>Implications for health policies: </strong>Allowing voluntarily committed patients to refuse medication may entice some to enter in-patient facilities, but the brief and optional exposure to medication and their side effects may actually discourage treatment and increase violence.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 3","pages":"141-54"},"PeriodicalIF":1.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34344563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Burden of Mental Illnesses in Pakistan.","authors":"Muhammad Ashar Malik,&nbsp;Murad Moosa Khan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The economic consequences of mental illnesses are much more than health consequences. In Low and Middle Income Countries (LMIC) the economic impact of mental illnesses is rarely analyzed. This paper attempts to fill the gap in research on economics of mental health in LMIC. We provide economic burden of mental illness in Pakistan that can serve as an argument for reorienting health policy, resource allocation and priority settings.</p><p><strong>Aim: </strong>To estimate economic burden of mental illnesses in Pakistan.</p><p><strong>Methods: </strong>The study used prevalence based cost of illnesses approach using bottom-up costing methodology. We used Aga Khan University Hospital, Psychiatry department data set (N = 1882) on admission and ambulatory care for the year 2005-06. Healthcare cost data was obtained from finance department of the hospital. Productivity losses, caregiver and travel cost were estimated using socio-economic features of patients in the data set and data of national household survey. We used stratified random sampling and methods of ordinary least square multiple linear regressions to estimate cost on medicines for ambulatory care. All estimates of cost are based on 1000 bootstrap samples by ICD-10 disease classification. Prevalence data on mental illnesses from Pakistan and regional countries was used to estimate economic burden.</p><p><strong>Results: </strong>The economic burden of mental illnesses in Pakistan was Pakistan Rupees (PKR) 250,483 million (USD 4264.27 million) in 2006. Medical care costs and productivity losses contributed 37% and 58.97% of the economic burden respectively. Tertiary care admissions costs were 70% of total medical care costs. The average length of stay (LOS) for admissions care was around 8 days. Daily average medical care cost of admitted patients was PKR 3273 (USD 55.72). For ambulatory care, on average a patient visited the clinic twice a year. The estimated average yearly cost for all mental illnesses was PKR 81,922 (USD 1394.65) and PKR 19,592 (USD 333.54) for admissions and ambulatory care respectively. In the sensitivity analysis productivity losses showed high variability (from USD 1022.17 million to USD 4007.01 million). Assuming a gate keeping role of primary healthcare (PHC) demonstrated a saving of USD 1577.19 million in total economic burden.</p><p><strong>Implications for health policy: </strong>This study set out to generate evidence using a low cost innovative approach relevant to many LMICs. In Pakistan, like many LMICs, patients access tertiary care directly, even for illness that can be efficiently managed at PHC level. In economic terms the non-medical consequences of mental illnesses are far greater than medical consequences. Based on these finding we recommend, firstly, that mental illnesses should be prioritized equally as other illnesses in health policy and secondly there needs to be integration of mental health in primary health care i","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 3","pages":"155-66"},"PeriodicalIF":1.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34344564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Medicaid Financing and Equalization of African Americans' and Whites' Outpatient and Emergency Treatment Expenditures.","authors":"Lonnie R Snowden,&nbsp;Neal Wallace,&nbsp;Kate Cordell,&nbsp;Genevieve Graaf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>We investigated whether a new funding opportunity to finance mental health treatment, provided to autonomous county-level mental health systems without customary cost sharing requirements, equalized African American and White children's outpatient and emergency treatment expenditure inequalities. Using Whites as a benchmark, we considered expenditure patterns favoring Whites over African Americans (\"disparities\") and favoring African Americans over Whites (\"reverse disparities\").</p><p><strong>Methods: </strong>Settlement-mandated Early Periodic Screening Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. We analyzed Medi-Cal paid claims for mental health services delivered to youth (under 18 years of age) over 64 quarters for a study period covering July 1, 1991 through June 30, 2007 in controlled cross-sectional (systems), longitudinal (quarters) analyses.</p><p><strong>Results: </strong>Settlement-mandated increases in EPSDT treatment funding was associated with relatively greater African American vs. White expenditures for outpatient care when systems initially spent more on Whites. When systems initially spent more on African Americans, relative increases were greater for Whites for outpatient and emergency services.</p><p><strong>Conclusions: </strong>With new funding that requires no matching funds from the county, county mental health systems did reduce outpatient treatment expenditure inequalities. This was found to be true in counties that initially favored African Americans and in counties that initially favored Whites. Adopting a systems level perspective and taking account of initial conditions and trends can be critical for understanding inequalities.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 3","pages":"167-74"},"PeriodicalIF":1.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34344565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Beck Depression Inventory to the EQ-5D-3L in Patients with Depressive Disorders.","authors":"Thomas Grochtdreis,&nbsp;Christian Brettschneider,&nbsp;Andr Hajek,&nbsp;Katharina Schierz,&nbsp;Juergen Hoyer,&nbsp;Hans-Helmut Koenig","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>For cost-utility analyses, data on health state utilities, as provided by the EQ-5D-3L, is needed but not always available. This study specified mapping algorithms from the Beck Depression Inventory (BDI) index to the EQ-5D-3L index adjusted for specific socio-demographic variables for patients with depressive disorders.</p><p><strong>Aims of the study: </strong>The objective of this study was to specify mapping algorithms from the BDI index to the preference-based EQ-5D index for patients with depressive disorders, adjusting for specific socio-demographic variables.</p><p><strong>Methods: </strong>A sample of 1,074 consecutive patients with depressive disorders from a psychotherapeutic outpatient clinic was included in the study. Standardized clinical interviews were applied to establish reliable diagnoses. For the prediction of the EQ-5D-3L index from the BDI index and selected patient socio-demographic characteristics, ordinary least squares regression with robust standard errors was used. Model prediction properties were tested using the root mean squared error and repeated random sub-sampling cross-validation.</p><p><strong>Results: </strong>The BDI index predicted the EQ-5D-3L index with a significant proportion of variance explained. The highest model goodness of fit was estimated for models with the BDI index and age as independent variables. The root mean squared error of the predicted EQ-5D-3L index in the validation samples was 0.23 for all models.</p><p><strong>Discussion: </strong>The mean observed EQ-5D-3L index values and the mean predicted EQ-5D-3L index values seemed not to differ between models. However, a reduction of variability using cross-validation led to those (rather) accurate mean predicted values. One limitation of this study was the restricted generalizability. Moreover, some uncertainty was introduced in model predictive performance by usage of a dependent estimation sample for validation.</p><p><strong>Implications for further research: </strong>The specified mapping algorithms from the BDI index to the EQ-5D-3L index for patients with depressive disorders are acceptable as approximation in cost-utility analyses. A further validation in independent samples is necessary to obtain more confidence in their performance.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 2","pages":"79-89"},"PeriodicalIF":1.6,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34589384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.","authors":"Lisa Wellander,&nbsp;Michael B Wells,&nbsp;Inna Feldman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial.</p><p><strong>Aims of the study: </strong>The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice.</p><p><strong>Methods: </strong>This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required.</p><p><strong>Results: </strong>The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depress","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 2","pages":"91-101"},"PeriodicalIF":1.6,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34589385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}