Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 5, Issue 3, 2002. Pages: 115-120 Published Online: 9 Feb 2003 Copyright © 2002 ICMPE.

*Correspondence to: János Zámbori, M.D., OPNI-Semmelweis University, Department of Psychiatry, Addictology and Child Psychiatry, Nyéki út  10-12, Budapest 1021 - Hungary        
Tel.:  +36-1-394 5311
Fax:  +36-1-394 6076 
E-mail: zambori@freemail.hu

Source of Funding: Servier Educational Fund.

Abstract

This study complements a controlled trial to analyze the cost of standardized treatment compared with the “usual care” provided by primary care physicians. A controlled trial was conducted, in which primary care patients meeting DSM-III-R criteria for anxiety and/or affective disorders were assigned to therapy with psychiatrists or the usual care of a primary care physician. The costs of care were calculated and the incremental costs for the different treatments were estimated. In terms of direct costs, psychiatric treatment consumed more resources than usual treatment, especially in terms of increased pharmaceutical costs. A partial offset effect of reduced non-psychiatric drug costs and laboratory and diagnostic test costs was found. The number of days spent on sick leave showed a large decrease with psychiatric treatment, and a sharp increase with usual care. Among primary care patients diagnosed with anxiety or affective disorders, psychiatric treatment led to higher direct costs, but this was offset by a decline in indirect costs due to reduced absenteeism compared with ordinary primary care.

Aim of the Study: The purpose of this paper is to estimate the changes in health utilization and indirect costs of anxiety and affective disorders in primary care patients after initiation of mental health treatment. Method: This study was conducted in 12 general practices for the primary care of adult populations in Budapest, Hungary. Among 2,000 eligible patients aged 18 to 64 years, 1,815 gave written informed consent to participate in the study. The Hungarian version of the  Diagnostic Interview Schedule (DIS) for anxiety and mood  disorders was used to generate psychiatric diagnoses. For all patients, health care utilization data for the previous 12 months was collected including number of visits, specialist consultations, days spent in hospital, sick days in the last year and prescribed medication. Among the first 1,000 attenders, 151 patients were given DIS/DSM-III-R diagnoses of current anxiety and/or mood disorder or uncomplicated bereavement. Fifty-one patients who agreed to psychiatric treatment were assigned to the treatment group. After the first 1,000 participants, 75 patients were given DIS diagnoses and were considered as controls. In the treatment group, five psychiatrists administered treatment on an outpatient basis for one year. Patients in the control group received “as-usual treatment” from their primary care physicians. After one year, health care utilization data for the study period was collected. For the purposes of this study, the direct costs considered were limited to health care expenses and the indirect costs were limited to lost workdays. Statistical significance was calculated using a paired-samples T-test procedure comparing the means of two variables for a simple group. Results: In the treatment group, the total cost of prescription drugs increased sharply due to psychiatric drug treatment, thus increasing the direct overall costs of care. In this same group the cost of non-psychiatric drugs showed a 37% decrease, suggesting that a reduction in general medical treatment partially offset the costs of anxiety and depression treatment. The number of hospital days showed marked decrease in the treatment group and a slight, insignificant increase in the control group. Absenteeism fell sharply in the treatment group (-56%) and in the group of patients who received  psychiatric treatment elsewhere (-62%). In the control group, there was a large upturn (+182%) in the number of days spent on sick leave. Discussion: Among primary care patients diagnosed with anxiety or affective disorders, psychiatric treatment led to higher direct costs, but this was offset by a decline in indirect costs due to reduced absenteeism compared with ordinary primary care. Limitations: Patients were not assigned randomly to the different groups because of ethical concerns. There were also significant differences in the baseline characteristics of the groups. Differences in the severity of illness and reasons not attributable to treatment effects may play a role in the change in the rate of service use. Implications for health policy: Limiting anxiety patients’ access to psychiatric treatment causes an increase in absenteeism, thus resulting in higher indirect costs.

Received 18 June 2002; accepted 2 December 2002

Copyright © 2002 ICMPE