Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 9, Issue 4, 2006. Pages: 193-200 Published Online: 21 December 2006 Copyright © 2006 ICMPE

* Correspondence to: Filip Smit, MSc., Trimbos Institute  (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 2500 AS Utrecht, The Netherlands
Tel.: +31-30-295 9254
Fax: +31-30-297 1111
E-mail: fsmit@trimbos.nl

Source of Funding: The Netherlands Ministry of Health (VWS), Grant # 63-505.

Abstract

There are relatively few cost-of-illness studies in the field of mental health that compare costs across well-diagnosed disorders. Data were used from a population-based psychiatric cohort study (N = 5,504) on DSM-III-R disorders. The costs of health service uptake and production losses were calculated for the reference year 2003. The following results were obtained. The annual per capita costs of the mood disorders (€ 5,009) were higher than those of anxiety disorders (€ 3,587) and alcohol-related disorders (€ 1,431). Costs related to production losses amounted to 85.2% of the total costs. The annual influx of new cases accounts for 39.2% of the costs at population level. It was concluded that (i) depression, dysthymia, panic disorder and social phobia are priority areas for cost-effective interventions, (ii) a much firmer role of preventive psychiatry is an economically sound idea, and that (iii) employers are de facto stakeholders in mental health promotion.

Background: Mental disorders are highly prevalent and are associated with substantial disease burden, but their economic costs have been relatively less well researched. Moreover, few cost-of-illness studies used population-based psychiatric surveys for estimating direct medical, direct non-medical and indirect costs, and were able to do so for several well diagnosed mental disorders. Aims: To calculate the cost of nine common mental disorders. The costs were calculated at individual level (per capita costs), and at population level per one million population for both prevalence (current cases) and incidence (new cases). Method: Data were derived from the Netherlands Mental Health Survey and Incidence Study (Nemesis), a population-based psychiatric cohort study among 5,504 adults in the age bracket of 18-65 years. DSM-III-R disorders were assessed with help of the Composite International Diagnostic Interview (CIDI). The costs of health service uptake, patients' out-of-pocket costs, and production losses were calculated for the reference year 2003. Robust regression methods, with 1,000 bootstrap replications, were used to estimate the excess costs of the distinct mental disorders and their 95% confidence intervals, while adjusting for physical illnesses and concurrent mental disorders in the regression equation. Results: The annual per capita excess costs of the mood disorders (e 5,009) were higher than those of the anxiety disorders (e 3,587) and alcohol-related disorders (e 1,431). Being more prevalent, the excess costs of anxiety disorders are higher than those of mood disorders at population level. The annual influx of new cases (incidence) accounts for 39.2% of the costs at population level. It appeared that in the general population, in the productive age of 18-65 years, the bulk of the costs (85%) were related to production losses. Discussion: The study has some strengths and limitations. The data were derived from a large and representative population-based sample. Disorders were assessed with a reliable instrument. The costs were comprehensive in that they included direct medical, direct non-medical and indirect costs. The costs attributable to mental disorders were obtained with robust regression models while adjusting for the presence of somatic illnesses. For several reasons the costs figures must be seen as conservative lower bounds of the true costs. (i) People who were hospitalised were likely to be underrepresented in the sample, and it is well known that hospitalisation is one of the major cost drivers. (ii) Resource use was based on self-report, and this is likely to have resulted in underreporting. (iii) Work loss days were included in the analysis, but work cutback data were unavailable, while it is known that the costs due to work cutback can be substantial. Implications: (i) The costs of mental disorders are comparable to those of physical illnesses. This throws some light on the allocation of budgets for research and development in mental versus physical illnesses. (ii) At population level a substantial part of the costs are caused by new cases, and this is a strong argument for strengthening the role of preventive psychiatry in public health with the aim to reduce incidence and avoid the future costs. (iii) In particular, reducing the incidence of major depression, panic disorder, agoraphobia and dysthymia should be considered as public health priorities, because these disorders are associated with substantial disability, and have, in addition, important economic ramifications. (iv) The bulk of the costs are due to production losses; this makes employers pertinent stakeholders in mental health promotion, and thoughts should be given to the question how to involve them more actively in health promotion. (v) It is well to emphasise that adoption of the above mentioned policies will require that first more prevention trials and cost-effectiveness studies are conducted in the selected disorders.

Received 6 February 2006; accepted 9 October 2006

Copyright © 2006 ICMPE