It Would be Cost-Effective to Treat More People with Mental Disorders

The press announcement following the February Council of Australian Governments meeting included a determination to improve mental health services. Issakidis and Andrews [1] analysed the 1997 National Survey of Mental Health and Well-being and showed that while eight out of 10 people with a mental disorder consult a general practitioner during the year, in less than a third was the mental disorder the focus of a consultation. A few patients sought help directly from specialist mental health services but, even so, only four out of 10 people with a mental disorder consulted a health professional for their mental disorder. Andrews et al . [2] reported on a comparison of the cost-effectiveness of treatment of 10 mental disorders. Data for three affective disorders (depression, dysthymia and bipolar), four anxiety disorders (panic, social phobia, generalized anxiety disorder and posttraumatic stress disorder), alcohol harmful use and dependence, and for schizophrenia, were compared in terms of cost, burden averted, and efficiency of current and optimal treatment. They then calculated the burden unable to be averted with current knowledge. The unit of health gain was a reduction in years lived with disability (YLDs, calculated as the prevalence times the change in disability weight). Summing across all disorders, current treatment averted 13% of the burden at an average cost of AUD$30 000 per YLD gained. Optimal treatment at current coverage could avert 20% of the burden at an average cost of $18 000 per YLD gained. Even at 100% coverage, 60% of the burden of mental disorders was deemed not to be avertable in the light of present knowledge. The situation in comparable physical disorders is different. Andrews et al . [3] and Simonella et al . [4] chose three physical disorders on the basis of similarities in burden, prevalence and natural history to be homologues of the anxiety disorders (asthma), depression (osteoarthritis) and schizophrenia (rheumatoid arthritis). The striking difference is in terms of the degree of coverage, with 92% of people with asthma or arthritis receiving treatment compare with only 42% of people with comparable mental disorder receiving treatment. In these three physical disorders current care averted 29% of the burden at a cost-effectiveness ratio of $14 000 per YLD. The comparable figures for mental disorders were 13% of the burden averted a $30 000 per YLD. Optimal care at current coverage was deemed capable of averting 54% of the burden of these physical disorders at $10 000/YLD gained. The figures for the comparable mental disorders were 20% of the burden at $18 000/YLD gained. Current and optimal care for mental disorders is half as effective and twice as costly as treatment for these physical disorders. The key policy questions remain: what is the cost, and is it cost-effective to increase the coverage of people with mental disorders to that approaching those of people with physical disorder? The basic data have been presented before, in table 4 in Andrews et al . [2], but appear to have been lost among the other findings. In the original study we modelled two optimal treatment scenarios for each disorder.