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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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The future of psychotherapy research: stop the waste and focus on issues that matter
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“…for mental disorders do not differ very much from those in general medical disorders (Leucht et al. 2012), but still it is estimated that current treatments cannot take away more than one-third of the disease burden of depression, and then only in optimal conditions (Andrews et al. 2004).”
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“[3] calculated that only 13 % of this burden can be averted by available treatments and that, even with improved coverage, clinician competence and adherence, only 36 % of the burden of depression could potentially be alleviated using current knowledge and therapies.”
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“Moreover, it has been reported that only 7% of people with SAnD receive ‘notionally effective treatment’ (Andrews et al., 2004).”
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“However, prior work has found that only about 20% to 30% of years lived with disability from depression can be avoided using these treatments.(37,38) While effective pharmacological and nonpharmacological treatments exist, research should be extending beyond a model of depression treatment, and use knowledge of risk a…”
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“Although evidence-based treatments exist, rates of treatment seeking are low, and many patients with depression do not receive adequate management, being the main barriers the limited availability of trained clinicians with consequent long waiting lists, direct and indirect costs of treatment, stigma, and difficulty a…”
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Solomon, D., Ford, E., Adams, J., & Graves, N. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2010.526094 · Cited by 21
“3 June 2010 ; accepted 19 September 2010 ) to be cost-effective [6], with a cost-effectiveness of $ 10 475 per year lived with disability (YLD), but current coverage has been estimated at only 60.”
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Meulenbeek, P. A. M., Willemse, G., Smit, F., van Balkom, A. V., Spinhoven, P., & Cuijpers, P. (2008) · Trials · doi:10.1186/1745-6215-9-67 · Cited by 24
“Furthermore, although there are effective treatments for PD [14], PD sufferers do not always receive empirically supported treatments; even if this were the case, the proportion of burden averted would still be low [15].”
Prevention: an achievable goal in personalized medicine
Cuijpers, P. (2009) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2009.11.4/pcuijpers · Cited by 18
“First, effective prevention programs may potentially contribute to the reduction of the enormous burden of mental disorders.(1) Mental disorders account for 22% of the total burden of disease in established market economies, as measured in disabilityadjusted life years lost,(2) with the common mental disorders (depres…”
The crisis in mental health: the chariot needs one horseman
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Batelaan, N. M., Smit, F., De Graaf, R., Van Balkom, A. J. L. M., Vollebergh, W. A. M., & Beekman, A. T. F. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01488.x · Cited by 27
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Defining Heterogeneous Cognitive Trajectories in Bipolar Disorder: A Perspective
Millett, C. E., & Burdick, K. E. (2021) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000297 · Cited by 20
Spreading the word: disseminating research results to patients and carers
Cleary, M. L., Walter, G., & Luscombe, G. M. (2007) · Acta Neuropsychiatrica · doi:10.1111/j.1601-5215.2007.00210.x · Cited by 20
“Immediate problems arise if the results do not yield the most cost-effective or efficient treatments (2) or, further still, are inconsistent with current mental health priorities and policy directives.”
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Fitzgerald, P. B., Montgomery, W. S., de Castella, A. R., Filia, K., Filia, S., Christova, L., Jackson, D., & Kulkarni, J. (2007) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670701579025 · Cited by 20
“present a theoretical model that estimates the relative efficiency of current treatment programmes for 10 different mental disorders [11].”
BackgroundUnderstanding Therapeutic Change Process Research Through Multilevel Modeling and Text Mining
Smink, W. A. C., Fox, J., Sang, E. T. K., Sools, A. M., Westerhof, G. J., & Veldkamp, B. P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01186 · Cited by 22
“…directly produce the textual interaction between therapist and counsellor, and come with the additional benefits that they are effective (see e.g., Andrews et al., 2004, 2010; Andersson et al., 2014), and easily accessible by large groups of people (Wang et al., 2007; Hoogendoorn et al., 2017).”
BackgroundCerón, S. C., Lokkerbol, J., Moreno-Peral, P., Wijnen, B. F. M., Fernández, A., Mendive, J. M., Smit, F., & Bellón, J. Á. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102064 · Cited by 20
The population impact of improvements in mental health services: the case of Australia
Jorm, A. F. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.111.097956 · Cited by 20
Preventing the Onset of Depressive Disorders: State of the Art and Future Directions
Cuijpers, P. J. (2024) · Current Directions in Psychological Science · doi:10.1177/09637214241297667 · Cited by 19
“Although evidence-based treatments are available (Cipriani et al., 2018; Cuijpers, Quero, et al., 2021), modeling studies have shown that current treatments can only reduce the disease burden of depression in the population by one third (Andrews et al., 2004).”
Internet interventions for depressive disorders: an overview
Cuijpers, P., & Riper, H. (2015) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.19.num.3.2014.13902 · Cited by 32
Consumer Feedback following Participation in a Family-Based Intervention for Youth Mental Health
Lewis, A. J., Bertino, M. D., Robertson, N., Knight, T., & Toumbourou, J. W. (2012) · Depression Research and Treatment · doi:10.1155/2012/235646 · Cited by 21
“…24 July 2012 Academic Editor: Amy Kilbourne Copyright © 2012 Andrew J. Lewis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.”
Mainstreaming Mental Health Care in 42 Countries
Shen, G. C., Eaton, J., & Snowden, L. R. (2017) · Health Systems & Reform · doi:10.1080/23288604.2017.1356424 · Cited by 19
“North America 1 (1) South Asia 11 (14) Sub-Saharan Africa 20 (25) Geographic region (World Health Organization) African 20 (25) Eastern Mediterranean 6 (8) European 19 (24) Americas 8 (10) Southeast Asia 12 (15) Western Pacific 14 (18) Gender Male 57 (72) Female 20 (25) Highest degree obtained Bachelor’s 6 (8) Master’…”
BackgroundDisease Burden and Disability-Adjusted Life Years Due to Schizophrenia and Psychotic Disorders
Theodoridou, A., & Wulf Rössler, A. (2009) · Springer eBooks · doi:10.1007/978-0-387-78665-0_87 · Cited by 19
Freund, J., Titzler, I., Thielecke, J., Braun, L., Baumeister, H., Berking, M., & Ebert, D. D. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02800-z · Cited by 21
“Existing evidence-based treatments for mental disorders have shown to only reduce the burden of mental health disorders by a third [13]; however, symptoms of mental disorders can be effectively reduced with preventive interventions [14, 15].”
BackgroundPrimary Prevention in Geriatric Psychiatry
Madhusoodanan, S., Ibrahim, F., & Malik, A. (2010) · Annals of Clinical Psychiatry · doi:10.1177/104012371002200404 · Cited by 18
Jacmon, J., Malouff, J., & Taylor, N. (2010) · E-Journal of Applied Psychology · doi:10.7790/ejap.v5i2.153 · Cited by 17
Fulgoni, C., Melvin, G. A., Jorm, A. F., Lawrence, K. A., & Yap, M. B. H. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100285 · Cited by 17
“, 2017) and even with optimal treatment, most of the burden of disease is not avertable (Andrews et al., 2004).”
BackgroundMoreno-Peral, P., Cerón, S. C., Luna, J. D. D., King, M., Nazareth, I., Martín-Pérez, C., Fernández-Alonso, C., Ballesta-Rodríguez, M. I., Fernández, A., Aiarzagüena, J. M., et al. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x714041 · Cited by 18
Lifetime treatment of DSM‐IV mental disorders in the Saudi National Mental Health Survey
Al‐Subaie, A. S., Altwaijri, Y. A., Alhabeeb, A. A., Bilal, L., Almeharish, A., Sampson, N. A., Liu, H., & Kessler, R. C. (2020) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1837 · Cited by 16
Bulloch, A. G., Currie, S. R., Guyn, L., Williams, J., Lavorato, D. H., & Patten, S. B. (2011) · Chronic diseases and injuries in Canada · doi:10.24095/hpcdp.31.3.07 · Cited by 17
First, Do No Harm: Referring Primary Care Patients with Depression to an Internet Support Group
Goodwin, B., Ford, D. E., Hsiung, R. C., Houston, T. K., Fogel, J., & Voorhees, B. W. V. (2017) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2017.0004 · Cited by 17
“It is estimated that less than half of those with depression seek help from a healthcare professional and even fewer receive appropriate treatment.(2,3) Both antidepressant medications and psychotherapy treat depression.”
BackgroundCost‐effectiveness of current and optimal treatment for adult asthma
Simonella, L., Marks, G. B., Sanderson, K. A., & Andrews, G. (2006) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2006.01054.x · Cited by 17
Self-citationMarkov models of major depression for linking psychiatric epidemiology to clinical practice.
Patten, S. B. (2005) · Clinical Practice and Epidemiology in Mental Health · doi:10.1186/1745-0179-1-2 · Cited by 17
Deady, M., Johnston, D. A., Glozier, N., Milne, D., Choi, I., Mackinnon, A., Mykletun, A., Calvo, R. A., Gayed, A., Bryant, R., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020510 · Cited by 14
“Although effective treatments are available, cost-effectiveness models suggest that even in the unlikely event of optimal treatment being delivered to all cases, only 35%–50% of the overall burden of common mental disorders would be alleviated.(6) As a result, effective preventative interventions, that intervene prior…”
BackgroundUnursaikhan, B., Tanaka, N., Sun, G.-H., Watanabe, S., Yoshii, M., Funahashi, K., Sekimoto, F., Hayashibara, F., Yoshizawa, Y., Choimaa, L., et al. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.642986 · Cited by 12
“Early-stage WCF-MSS-based MDD screening may enable effective and low-cost treatment (Andrews et al., 2004; Rush et al., 2006; Trivedi et al., 2006; Cuijpers et al., 2009).”
BackgroundCockayne, N. L., Duffy, S. L., Bonomally, R., English, A., Amminger, G. P., Mackinnon, A. J., Christensen, H. M., Naismith, S. L., & Hickie, I. B. (2015) · Trials · doi:10.1186/s13063-015-0762-6 · Cited by 17
“Even with optimal treatment of LLD, only 34 % of the disease burden in the form of ‘years lived with disability’ could be averted [7].”
BackgroundThe National Network of Depression Centers: progress through partnership
Greden, J. F. (2011) · Depression and Anxiety · doi:10.1002/da.20862 · Cited by 16
“[8–10] First, mental health investigators and clinicians have not adopted a common language for characterizing and monitoring clinical severity and outcomes, have not adopted standardized ‘‘vital signs’’ for mood disorders comparable to blood pressure readings for hypertension, and have not routinely employed measurem…”
BackgroundLawn, S., Huang, N., Zabeen, S., Smith, D., Battersby, M., Redpath, P., Glover, F., Venning, A., Cameron, J., & Fairweather‐Schmidt, A. K. (2019) · BMC Psychiatry · doi:10.1186/s12888-018-1987-1 · Cited by 17
“It is estimated that only one third of people diagnosed with depression actually receive any formal support [7], and up to 50% of these people may not be receiving evidence-based treatments [7, 8].”
BackgroundSelective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial
Deady, M., Collins, D., Lavender, I., Mackinnon, A. J., Glozier, N., Bryant, R. A., Christensen, H. M., & Harvey, S. B. (2023) · Journal of Medical Internet Research · doi:10.2196/45963 · Cited by 15
“However, evidence suggests that many mental health problems may be prevented [7], and the workplace is increasingly viewed as an appropriate avenue for preventative interventions [8].”
Sahle, B. W., Reavley, N. J., Morgan, A. J., Yap, M. B. H., Reupert, A., & Jorm, A. F. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05752-w · Cited by 20
“While increasing access to mental health services is central to improving population mental health, even if all those requiring treatment obtained it, approximately 60% of the burden of mental disorders would not be averted [7].”
BackgroundHarrer, M., Sprenger, A. A., Illing, S., Adriaanse, M. C., Albert, S. M., Allart, E., Almeida, O. P., Basanovic, J., van Bastelaar, K. M. P., Batterham, P. J., et al. (2025) · The British Journal of Psychiatry · doi:10.1192/bjp.2025.56 · Cited by 15
Sinnema, H., Terluin, B., Wensing, M., Volker, D., Franx, G. C., van Balkom, A. J. L. M., & de Lange, J. (2013) · BMC Family Practice · doi:10.1186/1471-2296-14-94 · Cited by 15
“It is important to overcome these factors, because enhancing guideline adherence yields to superior outcomes, is cost-effective, and leads to the reduction of the burden of the disease and to improved social functioning [14-16].”
BackgroundBeames, J. R., Lingam, R., Boydell, K., Calear, A. L., Torok, M. H., Maston, K., Zbukvic, I., Huckvale, K., Batterham, P. J., Christensen, H. M., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-042133 · Cited by 17
Young, C., Mohebbi, M., Staudacher, H. M., KAY‐LAMBKIN, F. J., Berk, M., Jacka, F. N., & O'Neil, A. E. (2021) · JMIR Mental Health · doi:10.2196/24871 · Cited by 14
“Even with full provision of established psychological and pharmacological treatments, it has been estimated that only 50% of the burden of the disease is addressed [4].”
Vigo, D., Jones, W. R., Dove, N., Maidana, D. E., Tallon, C., Small, W., & Samji, H. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211006872 · Cited by 15
“Methods: We developed a conceptual framework and a systematic methodology for combining available data sources to yield prevalence estimates for specific MSUDs.”
InfluentialEstimating health and productivity gains in England from selected interventions
Bevan, G., Airoldi, M., Morton, A., Oliveira, M. D., & Smith, J. D. (2007) · Cited by 15
It Would be Cost-Effective to Treat More People with Mental Disorders
Andrews, G. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2006.01859.x · Cited by 15
“[2], but appear to have been lost among the other findings.”
BackgroundResultSelf-citationChen, P. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02200-y · Cited by 16
“Treatment for depression in later life is costly and sometimes inefficient in reversing mental conditions [43].”
BackgroundGrummitt, L. R., Barrett, E. L., Halladay, J. E., Bailey, S., Birrell, L., Hunter, E., Kelly, E. V., Champion, K. E., Gardner, L. A., Nguyen, A., et al. (2023) · Mental Health & Prevention · doi:10.1016/j.mhp.2023.200308 · Cited by 16
Preventing Depression in Later Life: State of the Art and Science Circa 2011
Hindi, F., Dew, M. A., Albert, S. M., Lotrich, F. E., & Reynolds, C. F. (2010) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.11.008 · Cited by 14
Public Health Perspectives on Depressive Disorders
Cohen, N. L. (2017) · Johns Hopkins University Press eBooks · doi:10.1353/book.52762 · Cited by 15
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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