1. The health economic case for investment in primary care mental health David McDaid PRIMHE: Examining the future strategic direction of primary mental health care, February 2011, St Pancras Novotel LSE Health & Social Care and European Observatory on Health Systems and Policies, London School of Economics E-mail:d.mcdaid@lse.ac.uk
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4. Centre for Mental Health, 2010 http://www.centreformentalhealth.org.uk/pdfs/Economic_and_social_costs_2010.pdf
5. Costs of depression (adults) in England, 2000 Thomas & Morris Brit J Psychiatry 2003 Excluding ‘morbidity’ costs
6. Costs of depression (adults) in England, 2000 Total cost = £9 billion Thomas & Morris Brit J Psychiatry 2003
7. Costs of depression (adults) in England, 2000 Total cost = £9 billion Thomas & Morris Brit J Psychiatry 2003 Only measures unemployment and absenteeism; ‘presenteeism’ could double this cost
8. Disability Benefits GB 2007 Source: Department of Work and Pensions, 2007 € 3.9 billion per annum Plus reduced tax receipts €14 billion
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10. Economics is about choice Budget Choice ‘A’ Choice ‘B’ Resources are always constrained; How can we best spend public monies to maximise benefit to society Be mindful of potential consequences for fairness and equity
11. Economic evaluation The effectiveness question: Does this intervention work? The economic question: Is it worth it?
12. Two Basic Needs: (A) Costs and Outcomes; (B) 2+ Alternatives Outcomes (e.g. Quality of Life Years (QALYs) for intervention X Costs for intervention X Costs for intervention Z Outcomes (e.g Quality of Life Years (QALYs) for intervention Z Cost per QALY circa £30,000 considered good value; But need to be mindful of budgetary impact
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15. Health care costs of all medically unexplained symptoms in England 2009 Source: Bermingham, Cohen, Hague & Parsonage, 2010 £ 2.88 billion per annum 11% of all health care expenditure for working age population
16. Costs beyond health care system £9.25 £0.88 £8.37 Other Quality of Life Impacts Total Somatisation Disorder Sub-Threshold Disorders Cost’s £ Billions £17.37 £2.16 £15.21 Total £5.24 £0.45 £4.79 Lost Employment £2.88 £0.83 £2.05 Health Care Costs
17. Economic Modelling study Objective: To evaluate the cost effectiveness of detection in primary care followed by cognitive behavioural therapy for sub- threshold and somatoform disorders Outcomes: Improvement in Quality of Life Scores over 3 years Impact on employment rates over 3 years Impacts on use of NHS resources over 3 years Data: Cost data from NHS sources, Bermingham study; Cost of awareness training for GPs (including need for locums) from national sources; E-learning for GPs as alternative; IAPT cost data for CBT costs. Incidence of MUS from Bermingham study
18. NHS only NHS and Employment Impacts McDaid, Parsonage and Park, 2011
19. CBT for sub-threshold disorders pop coming into contact with GPs (e-learning model) -6,220 £per QALY gained (NHS plus productivity) 8,071 £/QALY gained (NHS) 35,958 QALYs gained -223,669,259 Net NHS and productivity costs per year -513,870,616 Productivity 290,201,357 Net NHS costs -122,218,965 A&E Care -199,879,589 Inpatient treatment -27,807,096 Outpatient consultations 787,349,160 CBT cost -33,233,116 Prescription costs -114,609,037 GP costs 600,000 CBT awareness training Total Costs/Savings Cost component
20. CBT for somatoform disorders pop coming into contact with GPs (e-learning model) -15,189 £per QALY gained (NHS plus productivity) -101 £/QALY gained (NHS) 42,074 QALYs gained -639,069,750 Net NHS and productivity costs per year -634,828,662 Productivity -4,241,088 Net NHS costs -190,020,975 A&E Care -442,914,724 Inpatient treatment -45,012,443 Outpatient consultations 847,613,160 CBT cost -39,168,358 Prescription costs -135,337,749 GP costs 600,000 CBT awareness training Total costs Cost Component
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23. Costs of health service use, by depression status Simon et al, Gen Hosp Psychiatry , 2005
24. Collaborative care to manage depression in people with diabetes in primary care: costs over 5 years Katon et al, Diabetes Care , 2008 Compared usual primary care and a nurse depression intervention (12 months - education, behaviour activation, choice between medication and problem-solving therapy) Requires better early recognition of co-morbidity
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