Mental health

A societal perspective is common according to the health economic guidelines. Currently there is interest to even include broader effects (i.e. exceeding the patient and exceeding health care) . This is especially relevant to illness in children and disorders, which have a high impact on third parties (such as ADHD). iMTA develops models that adds to the current movement towards broader considerations in cost-effectiveness analyses.

In our recent study into ADHD among adolescents it was shown that key cost-drivers for ADHD are health care consumption (i.e. psychological treatment). Interestingly, costs of this disease were also caused by parents, who suffer loss of productivity as they face absence from work and lower productivity at work. For the mother of the child, lower levels of quality of life are reported.

The prevalence of mental illness is high, as well as the societal costs. Our studies show the impact of productivity costs on the costs effectiveness. Several studies were conducted on collaborative care, currently more and more applied in mental health care. Study show that the treatment of an anxiety disorder with collaborative care verses only Cognitive Behavioral Therapy (CBT) is very cost-effective. So is short psychotherapy versus ambulant care in personality disorders. For eating disorders, cognitive remediation therapy + CBT was not cost-effective compared to only CBT.

Two recent systematic reviews within mental health care focused on schizophrenia and on systemic care for youth delinquents. The schizophrenia study showed that unemployment is very common in this patient group. The systematic review on systemic care for youth delinquents was performed to identify mental health issues. It was shown that this group is often physically rather healthy, and often do not report problems on EQ5D. The review highlighted the need for a new preference based measure for youth delinquency, which is currently under development at iMTA.

Patients with severe and complex mental disorders are often treated ineffectively, partly due to limited early recognition. The allocation of care to these patients in relation to their actual treatment needs, costs, and outcomes, therefore needs attention. iMTA works in cooperation with TOPGGz and many Mental health organisations, e.a. de Viersprong, PsyQ, Altrecht eetstoornissen Rintveld, GGz Rivierduinen, to develop of a evidence-based practical tool to identify complex and/or severe patients in an earlier phase. This tool should enhance quality and efficiency of care. Moreover, the quality of life of the patients will increase.

eHealth is an increasing type of treatment in mental health care. Internet based CBT (iCBT) can increase availability, has proven to be at least equally effective and requires less therapist time. Blended eHealth is a combination treatment, in which regular face-to-face CBT contacts are partially replaced by iCBT and is applied in secondary mental health care. Currently, iMTA in cooperation with Altrecht investigate cost-effectiveness of blended eHealth treatment versus treatment as usual for patients with anxiety disorders in secondary mental health care.