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Utilising survey data to inform public policy: Comparison of the cost-effectiveness of treatment of ten mental disorders
Open accessAbstract
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 in terms 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 AUS$30 000 per YLD gained. Optimal treatment at current coverage could avert 20% of the burden, at an average cost of AUS$18 000 per YLD gained. Optimal treatment at optimal coverage could avert 28% of the burden, at AUS$16 000 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.
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“In a utopian world, even if unlimited funding were available, three-quarters of the burden of schizophrenia would remain unavoidable [240].”
From A Systematic Review of the Prevalence of Schizophrenia (2005) · cites this paper as [240]
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“If we improve efficiencies within the current services, we can do somewhat better (22%).”
From A Systematic Review of the Prevalence of Schizophrenia (2005) · cites this paper as [240]
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“For schizophrenia, with the current mix of interventions we can only reduce 13% of the burden.”
From A Systematic Review of the Prevalence of Schizophrenia (2005) · cites this paper as [240]
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Smit, F., Willemse, G., Koopmanschap, M. A., Onrust, S. A., Cuijpers, P. J., & Beekman, A. T. F. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.188.4.330 · Cited by 117
Randomized Controlled Trial of Web-Based Treatment of Social Phobia Without Clinician Guidance
Titov, N., Andrews, G., Choi, I., Schwencke, G., & Johnston, L. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670903179160 · Cited by 122
“18 000 disability adjusted life years lost) but only one in five people with the disorder sought treatment, and only 8% of the burden was averted by current treatment [1,2].”
BackgroundSelf-citationMoreno-Peral, P., Conejo-Cerón, S., Rubio-Valera, M., Fernández, A., Navas-Campaña, D., Rodríguez-Morejón, A., Motrico, E., Rigabert, A., Luna, J. D. D., Martín-Pérez, C., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2509 · Cited by 115
“Although there are effective treatments for anxiety disorders,(4-6)not all personswith anxiety receive the appropriate treatment,(7) and cost-effectiveness studies suggest that treatment alone is not sufficient to eliminate thediseaseburdenattributable toanxietydisorders.(8) An additional way to reduce the burden of a…”
BackgroundCook, L., Mostazir, M., & Watkins, E. R. (2019) · Journal of Medical Internet Research · doi:10.2196/11349 · Cited by 112
Lee, E., Cho, H. J., Olmstead, R., Levin, M. J., Oxman, M. N., & Irwin, M. R. (2013) · Sleep · doi:10.5665/sleep.3128 · Cited by 113
Harris, M. G., Diminic, S., Reavley, N., Baxter, A., Pirkis, J., & Whiteford, H. A. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415577434 · Cited by 113
“A significant proportion of the burden associated with mental and substance use disorders is avertable with existing therapies (Andrews et al., 2004) but, in developed countries, less than half of people with these disorders will seek professional help in a given year (Burgess et al.”
BackgroundEconomic costs of full-blown and subthreshold panic disorder
Batelaan, N. M., Smit, F., de Graaf, R., van Balkom, A. J. L. M., Vollebergh, W., & Beekman, A. T. F. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.03.013 · Cited by 116
Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Altwaijri, Y., Andrade, L. H., Cardoso, G., et al. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1107 · Cited by 100
DSM-IV and DSM-5 social anxiety disorder in the Australian community
Crome, E., Grove, R., Baillie, A. J., Sunderland, M., Teesson, M., & Slade, T. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414546699 · Cited by 100
“Email erica.crome@mq.edu.au Australian & New Zealand Journal of Psychiatry, 49(3) understanding of SAD is up to date is essential for informing service planning, policy reform, clinical practice and foundational research (Andrews et al., 2004; Whiteford and Groves, 2009).”
BackgroundAustralian mental health reform: time for real outcomes
Hickie, I. B., Davenport, T. A., Luscombe, G. M., Groom, G. L., & McGorry, P. D. (2005) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2005.tb06759.x · Cited by 98
Preventing Depression in Final Year Secondary Students: School-Based Randomized Controlled Trial
Perry, Y., Werner-Seidler, A., Calear, A., Mackinnon, A., King, C., Scott, J., Merry, S., Fleming, T., Stasiak, K., Christensen, H., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8241 · Cited by 112
“It has been estimated that, at most, only 36% of the burden of depression could potentially be alleviated using current knowledge and therapies [2].”
Fernández, A., Pinto‐Meza, A., Bellón, J. Á., Poch, P. R., Haro, J. M., Autonell, J., Palao, D. J., Peñarrubia‐María, M. T., Fernández‐Vergel, R., Blanco, E., et al. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2009.11.015 · Cited by 101
Stepped care for depression in primary care: what should be offered and how?
van Straten, A., Seekles, W., Veer-Tazelaar, N. V. ’., Beekman, A. T. F., & Cuijpers, P. J. (2010) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03691.x · Cited by 96
“Although precise estimates are lacking, it has been suggested that this is true for as much as 50% of all cases.[6]”
BackgroundHarris, M., Hobbs, M. J., Burgess, P. M., Pirkis, J., Diminic, S., Siskind, D. J., Andrews, G., & Whiteford, H. (2015) · The Medical Journal of Australia · doi:10.5694/mja14.00297 · Cited by 96
Self-citationDias, A., Azariah, F., Anderson, S. J., Sequeira, M., Cohen, A., Morse, J. Q., Cuijpers, P., Patel, V., & Reynolds, C. F. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.3048 · Cited by 93
“Limitations The limitations of the current study include the following: (1) the exclusion of persons with mild cognitive impairment or dementia, who may require a modified approach to the DIL intervention; (2) the limited follow-up period to determine durability of effect; (3) the absence of data on biomarkers of risk…”
MethodCost-effectiveness of current and optimal treatment for schizophrenia
Andrews, G., Sanderson, K., Corry, J., Issakidis, C., & Lapsley, H. (2003) · British Journal of Psychiatry · doi:10.1192/bjp.183.5.427 · Cited by 83
Self-citationMyths and plain truths about schizophrenia epidemiology – the NAPE lecture 2004
McGrath, J. J. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00467.x · Cited by 90
“Recently, startling findings have emerged from research about best buys with respect to the cost of averting disability (39, 40).”
BackgroundWang, X., Xie, H., Chen, T., Cotton, A. S., Salminen, L. E., Logue, M. W., Clarke‐Rubright, E. K., Wall, J. T., Dennis, E. L., O’Leary, E. N., et al. (2020) · Molecular Psychiatry · doi:10.1038/s41380-020-00967-1 · Cited by 92
“The personal suffering associated with PTSD, coupled with residual symptoms and functional impairments that persist even after pharmacological and behavioral treatments, results in major fi nancial and societal costs [4, 5].”
van Steenbergen-Weijenburg, K. M., Feltz-Cornelis, C. M. V. D., Horn, E. K., van Marwijk, H., Beekman, A. T. F., Rutten, F., & Roijen, L. H. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-19 · Cited by 89
“Although several effective treatment options for depression are available, their impact on the societal burden or costs of depression remains limited [3].”
BackgroundKelders, S. M., Bohlmeijer, E. T., & Van Gemert-Pijnen, J. E. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2258 · Cited by 88
“Research shows that easily accessible interventions for indicated prevention (targeted at people at risk) are essential and can be cost-effective [1-3].”
Hilbink, M., Laurant, M. G. H., Verhaak, P. F. M., Prins, M., van Marwijk, H., Penninx, B. W. J. H., Wensing, M., & Grol, R. P. T. M. (2009) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2009.05.011 · Cited by 87
“In addition, treatment meeting clinical guidelines is also cost effective [19].”
BackgroundLee, Y. Y., Barendregt, J. J., Stockings, E. A., Ferrari, A. J., Whiteford, H. A., Patton, G. A., & Mihalopoulos, C. (2017) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796016000469 · Cited by 85
“For example, Andrews et al. (2004) found that around 66% of the overall burden of major depression would remain unaverted by evidence-based treatments despite an optimal effective coverage of 100%.”
BackgroundPreventing depression using a smartphone app: a randomized controlled trial
Deady, M., Glozier, N., Calvo, R., Johnston, D., Mackinnon, A., Milne, D., Choi, I., Gayed, A., Peters, D., Bryant, R., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291720002081 · Cited by 85
“Although effective treatments are available, cost-effectiveness models suggest that even if optimal treatment were delivered to all of those in need, only 35 to 50% of the overall burden of these conditions would be alleviated (Andrews et al., 2004).”
BackgroundWaters, A. M., Zimmer-Gembeck, M. J., Craske, M. G., Pine, D. S., Bradley, B. P., & Mogg, K. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.08.005 · Cited by 80
Vos, T., Haby, M. M., Magnus, A., Mihalopoulos, C., Andrews, G., & Carter, R. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2005.01654.x · Cited by 85
Self-citationCommunity factors influencing child and adolescent depression: A systematic review and meta-analysis
Stirling, K., Toumbourou, J. W., & Rowland, B. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415603129 · Cited by 91
“However, even in a perfect health care system, modelling suggests that only 35% of the burden of affective disorders could be averted through optimal treatment (Andrews et al., 2004).”
BackgroundDevelopment of a web-based intervention for the indicated prevention of depression
Kelders, S. M., Pots, W. T., Oskam, M. J., Bohlmeijer, E. T., & van Gemert-Pijnen, J. E. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-26 · Cited by 80
“To reduce the large public health burden of the high prevalence of depression, preventive interventions targeted at people at risk (indicated prevention) are essential and can be cost-effective [1,2].”
Background
Metadata
- Authors
- Andrews, G., Issakidis, C., Sanderson, K., Corry, J., & Lapsley, H.
- Affiliations
- UNSW Sydney (AU)
- Queensland University of Technology (AU)
- The University of Queensland (AU)
- Corresponding author
- Andrews, Gavin
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2004-06
- Volume
- 184
- Issue
- 6
- Pages
- 526-533
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W94943583
- Cited by
- 560
- References
- 29
- Citations by year
- 2026: 10 · 2025: 22 · 2024: 13 · 2023: 42 · 2022: 16 · 2021: 36 · 2020: 38 · 2019: 24 · 2018: 24 · 2017: 35 · 2016: 21 · 2015: 34 · 2014: 29 · 2013: 31 · 2012: 24
- FWCI
- 48.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Centre for Health Research; Faculty of Health; Institute of Health and Biomedical Innovation
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- mental illness, cost-effectiveness, psychotherapy, disease burden, years lived with disability, mood disorders, anxiety disorders, alcoholism, schizophrenia, treatment coverage, public policy
- MeSH terms
- Anxiety Disorders, Australia, Mental Disorders, Bipolar Disorder, Cost-Benefit Analysis, Health Policy, Health Surveys, Humans, Mental Health Services, Psychoses, Alcoholic, Schizophrenia, Time Factors, Cost of Illness, Evidence-Based Medicine, Mood Disorders
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