Making the economic case for investing in child and adolescent mental health services

Abstract

Objectives: As part of work undertaken for the EC supported Child and Adolescent Mental Health in Enlarged Europe (CAMHEE) project, an analysis of the economics of child and adolescent mental health was conducted. Firstly this mapped what was known about both the economic costs of child and adolescent mental disorders and the economic case for investment in services for their prevention and treatment. Secondly, decision analysis models were constructed to illustrate how the potential cost effectiveness of preventive interventions may be determined in countries where, to date, few attempts have been made to determine cost effectiveness. Methods: A systematic literature review was conducted, in line with guidelines developed by the NHS Centre for Reviews and Dissemination. The aim was to identify studies quantifying the economic costs of poor child and adolescent mental health (CAMH) and economic evaluations of CAMH interventions. Database searched included the Applied Social Sciences Index and Abstracts, Pubmed/Medline, ERIC, EMBASE, Psychinfo, International Bibliography of the Social Science, Econlit, and the NHS Economic Evaluation Database. This was complemented by a handsearch of key journals and selected governmental, non-governmental organisation and academic websites. Decision analytical models were constructed using TreeAge Pro software to synthesise data on local costs with information from the literature review on the effectiveness of services to estimate the potential cost effectiveness of preventive interventions across six countries: Bulgaria, England, Germany, Greece, Lithuania and Norway. Local costs and resource use data in six European countries were identified by CAMHEE partners making use of a modified version of the Client Service Receipt Inventory (CSRI). Results: Cost of illness studies identified were of variable quality; only a minority looked at costs outside the health system. However it was clear from those studies that did take a broad perspective that the majority of the economic costs of poor CAMH fall on other sectors including education, criminal justice, employment and social welfare. No cost of illness or cost effectiveness studies in the new member states of the EU were identified. 19 cost effectiveness studies meeting our criteria were identified, nearly all of which were from the United States and the United Kingdom. Two studies focused on the primary prevention of CAMH problems, while the remainder focused on the alleviation of problems in children identified as being at risk. The results of decision analytical models looking at the use of parenting interventions not only indicated that these would be considered cost effective in all six European countries, but in several instances would be cost saving given the substantial long term costs avoided. Conclusions: While knowledge on the costs of poor child and adolescent mental health continues to increase, published studies on the cost effectiveness of interventions to prevent/and or alleviate these problems remain limited. Much of this published literature is from the United States and the United Kingdom raising questions about the extent to which results can be generalised to other contexts and settings. However, making use of local resource data, it is clear that CAMH interventions have the potential to be highly cost effective in a number of high and middle income countries, largely because of the substantial long term economic costs that may be avoided through early intervention