1

2

?

Q2 – Q1!

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$$$$$$!!!

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You’re both right. ($2 – $1) /(Q2 – Q1)

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ECONOMIC EVALUATION IN MENTAL HEALTH

Philip Jacobs / Alain Lesage March 14, 2018 NOAHE Evidence into practice

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Economics…

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Its all about limited, scarce

means (resources)….

Its all about limited, scarce means (resources)….

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…which can fulfill unlimited

ends (goals).

…which can fulfill unlimited ends (goals).

Mental health economics is wider than mental healthcare resources

• Focuses on the impact and treatment of mental illnesses. • Mental healthcare resources:

- Psychiatrists, psychologists, counsellors, nurses, teams - Hospital care, ED - Pharmaceuticals - Community / residential Related resources - Social services - Criminal justice - Education - Housing - Counseling

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The economic burden of mental illness goes beyond resources

Resources - Direct - Indirect / productivity / workloss Transfer payments “Human costs” pain and suffering / intangibles

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Types of economic studies

• Economic burden

• Economic analysis (supply and demand)

• Economic Evaluation (Cost – consequences, CEA, CBA, SROI)

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Economic burden – direct costs

12 Wang, Cdn J Psy 2017

Provincial mental health-related expenditures for youths age 12-17, Alberta, 2014/5

Hospital 19%

ED 2%

Psychiatrist 10%

GP 2%

FSCD 8%

Crim Justice 10%

Altern Jud Meas 0%

Pub Sch Counsel 49%

COST ($154 MILLIONS)

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Missing: Residential treatment, community mental health, children’s services, drugs Compilation: P.Jacobs

Economic evaluations

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•C2 – C1 /Q2 – Q1

• 1,2 are alternative interventions • The change in costs in relation to the change in outcome • CADTH Guidelines:

– Comparator interventions (1,2) – Perspective (choose C) – Timelines – Outcomes (Q) – Costs (C)

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Economic evaluation example…1 • Target group

– Youths 12 – 18(mostly female) – 1 to 3 mental health hospitalizations per 6 mos. – Caregivers (parents)

• Intervention – Combined clinical, social service, education

• Comparator intervention – “Normal” conditions, separate services

• Purpose – to improve conditions leading to hospitalization • Perspective

– Government • Program + education, criminal justice, social services

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Economic evaluation example…2

• Timelines - Duration of program (about 300 days admission to discharge) – 6 months pre-admission – 6 months post discharge

• Outcomes – Standard: “Utility” or QALYs. – This analysis: Child wellness index (CGAS) and

selected outcomes for caregivers

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Economic evaluation example …3

• Costs - Program costs (about 300 days)$140,000 - Less: program opportunity costs $48,000 - Less net non-program costs p.a. $40,000 Net program cost(first year post discharge) $52,000 Net gain each subsequent year $40,000 Payback 2.3 years

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Economic evaluation example…4

• The cost – consequences of program – For one year post program:

- Net cost per youth, $52,000 - Gains in CGAS per child, one category - Gains in well-being for caregivers

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Some problems

• Difficult to get QALYs in youths • Counter-factual, alternative intervention

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