Huajie Jin
Ali Jalali
Ben Wijnen
Yuhua Bao- 1King's Health Economics (KHE), Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, United Kingdom
- 2Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
- 3Center for Economic Evaluations, Trimbos Institute, Utrecht, Netherlands
Editorial on the Research Topic
Economic evaluation of mental health interventions
Introduction
Mental health disorders affected more than 1 billion people globally and were responsible for 7% of the global burden of disease as measured in Disability Adjusted Life Years (DALYs) and 19% of all years lived with disability (1). Economic evaluation is increasingly employed to guide resource allocation decisions and policymaking in mental health.
Our Research Topic showcases cutting-edge economic evaluations in mental health to inform public and private resource decisions. It includes nine papers: two partial economic evaluations focusing solely on the costs of interventions/diseases, three full economic evaluations assessing both costs and consequences of interventions, two systematic reviews, one perspective paper, and one protocol paper.
Partial economic evaluations
Based on data from two RCTs, Paterson et al. estimated that delivering a mental health recovery narrative web application costs £349 per user for those with psychosis and £241 per user for those without psychosis. Crucially, this study accounts for intervention development costs, which is important but often overlooked in costing studies. The results of this study can be used to estimate the cost of delivering NEON at scale and improve consistency in reporting of cost for similar digital health interventions.
Based on multiple sources of information, Sousa et al. estimates the total disease burden of Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal at 66.3 thousand DALYs. Direct costs were €30.8 million, mainly from medical appointments and medication. Adding productivity losses, the total cost reached €1.1 billion. This study emphasized the need for prioritizing health promotions for both disorders.
Full economic evaluations
Of the three full economic evaluations included in this topic, Le Novere et al. conducted a trial-based economic evaluation, in which the trial provides the main source of input data; while Liu et al.(a) and Kleijburg et al. employed a decision-analytic modeling approach.
Le Novere et al. assessed the cost-effectiveness of peer-supported self-management for people discharged from mental health crisis teams in England, from a mental health service perspective. Compared to usual care, the intervention had a 57% chance of being cost-effective at £20,000 per QALY gained. The main methodological challenge in this study is the significant (nearly 50%) missing data for the utility outcome, while data regarding resource use were nearly complete. This study illustrates how common strategies to address missingness or distributional features of cost and utility data may or may not mitigate biases.
Both Liu et al.(a) and Kleijburg et al. employed a Markov modeling approach, dividing the disease into distinct states with assigned transition probabilities for movement over discrete time periods, known as “Markov cycles” (2). By attaching costs and health outcomes to each of these states and using intervention-specific transition probabilities, a Markov model can be used to estimate the long-term costs and outcomes for the interventions of interest.
Using a previously published model, Liu et al.(b) found that lurasidone was a dominant treatment compared to olanzapine and risperidone in the first-line treatment of schizophrenia in China, resulting in greater QALY gains at lower costs. Kleijburg et al. reported the development of TiBipoMod—A model which can simulates the lifetime costs and health outcomes for various interventions in the treatment of bipolar disorders type I and II, from a societal perspective. A case study conducted based on TiBipoMod showed that mindfulness-based cognitive therapy dominates standard care.
Systematic reviews
Systematic reviews of economic evaluations of healthcare programs and interventions can synthesize crucial data to inform healthcare decision-making and highlight research priorities (3). However, synthesizing evidence from such studies is challenging given inconsistencies in cost-effectiveness research designs (e.g., synthesizing evidence from simulation and trial-based analyses) and reporting guidelines (4, 5). The two systematic reviews included in this Research Topic are notable in that they both follow the Consensus on Health Economic Criteria (CHEC) list for assessing the methodological quality of economic evaluations in systematic reviews (6), and both provide a thorough discussion of the limitations in consolidating evidence across the included studies.
Kugener et al. provide a timely update on the economic evidence for prevention and treatment interventions for child maltreatment, abuse and neglect in high-income countries (US, Australia, UK, Canada). Their study evaluated a total of 11 studies, 7 of which were model-based economic evaluations while 4 were conducted alongside a clinical trial. All studies demonstrated improved outcomes at common cost-effectiveness value thresholds, with two demonstrating cost-savings in addition to effectiveness gains. Kugener et al. noted that cross study comparisons and/or pooling was made difficult due to limited comparability of measures across studies, including lack of commonly applied terminology for child maltreatment, as well as variation in the methodological rigor such as hand lined missing data, which continues to be an issue in the field (7).
Hannah et al. reviewed economic evidence pertaining to interventions for treatment-resistant depression. Their review encompassed 31 studies-−11 conducted alongside clinical trials, and 20 used modeling methods. Similar to Kugener et al., Hannah et al. identified heterogeneity in methodological quality, most notably finding that fewer than half of the model-based evaluations conducted a comprehensive sensitivity analysis of model parameters. An important feature of Hannah et al.'s review is their in-depth discussion on the divergences between the model vs. trial approaches to economic evaluations.
Others
The successful implementation of mental health interventions, particularly behavioral health interventions, frequently demands significant stakeholder engagement. Nonetheless, the expenses associated with this involvement are commonly overlooked in current economic evaluations. In their perspective paper, Raciborski et al. delve into the integration of stakeholder engagement with established economic analysis methods, aiming to enhance decision-making regarding the implementation of behavioral health interventions.
Shah et al. reports on a protocol for a return-on-investment analysis of system-wide service transformation for young people experiencing mental health problems in Canada. Novelties of the proposed study lie in two aspects: economic evaluation of a system transformation (rather than a particular health technology) and assessing population-wide implications of the system intervention (thus capturing complex links between intervention and outcomes and spillovers). Findings of the proposed studies will inform decisions regarding large scale, system transformation initiatives designed to benefit population health.
Author contributions
HJ: Conceptualization, Data curation, Investigation, Methodology, Writing—original draft, Writing—review and editing. AJ: Conceptualization, Data curation, Investigation, Methodology, Writing—original draft, Writing—review and editing. BW: Conceptualization, Data curation, Investigation, Methodology, Writing—original draft, Writing—review and editing. YB: Conceptualization, Data curation, Investigation, Methodology, Writing—original draft, Writing—review and editing.
Acknowledgments
We thank authors of the papers published in this Research Topic for their valuable contributions and the referees for their rigorous review.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Rehm J, Shield KD. Global burden of disease and the impact of mental and addictive disorders. Curr Psych Rep. (2019) 21:997. doi: 10.1007/s11920-019-0997-0
2. Briggs A, Sculpher M. An introduction to Markov modelling for economic evaluation. Pharmacoeconomics. (1998) 13:4. doi: 10.2165/00019053-199813040-00003
3. Jalali A, Ryan DA, McCollister KE, Marsch LA, Schackman BR, Murphy SM. Economic evaluation in the national drug abuse treatment clinical trials network: past, present, and future. J Subst Abuse Treat. (2020) 112:18–27. doi: 10.1016/j.jsat.2020.02.002
4. Jacobsen E, Boyers D, Avenell A. Challenges of systematic reviews of economic evaluations: a review of recent reviews and an obesity case study. Pharmacoeconomics. (2020) 38:259–67. doi: 10.1007/s40273-019-00878-2
5. Anderson R. Systematic reviews of economic evaluations: utility or futility? Health Econ. (2010) 19:350–64. doi: 10.1002/hec.1486
6. Evers S, Goossens M, De Vet H, Van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria. Int J Technol Assess Health Care. (2005) 21:240–5. doi: 10.1017/S0266462305050324
Keywords: economic evaluation, editorial, mental health, cost-effectiveness analysis, cost-of-illness
Citation: Jin H, Jalali A, Wijnen B and Bao Y (2023) Editorial: Economic evaluation of mental health interventions. Front. Psychiatry 14:1294245. doi: 10.3389/fpsyt.2023.1294245
Received: 14 September 2023; Accepted: 18 September 2023;
Published: 28 September 2023.
Edited and reviewed by: Wulf Rössler, Charité University Medicine Berlin, Germany
Copyright © 2023 Jin, Jalali, Wijnen and Bao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Huajie Jin, huajie.jin@kcl.ac.uk