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Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

journal contribution
posted on 01.01.2004, 00:00 authored by Cathy Mihalopoulos, Annette Magnus, Rob CarterRob Carter, T Vos
Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

History

Journal

Australian and New Zealand journal of psychiatry

Volume

38

Issue

7

Pagination

511 - 519

Publisher

Wiley Interscience

Location

Malden, Mass.

ISSN

0004-8674

eISSN

1440-1614

Language

eng

Notes

Published Online: 15 Jul 2004

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2006 The Authors; Journal compilation and The Royal Australian and New Zealand College of Psychiatrists