Prevention: wrestling with new economic realities

Purpose – The purpose of this paper is to discuss the economic pressures on long-term care systems, and describe how an economic case might be made for better care, support and preventive strategies. Design/methodology/approach – Discussion of recent developments and research responses, with illustrations from previous studies. Findings – Economics evidence is highly relevant to decision makers in health, social care, and related systems. When resources are especially tight, economics evidence can sometimes persuade uncertain commissioners and others to adopt courses of action that improve the wellbeing of individuals, families, and communities. Originality/value – The paper uses long-established approaches in economic evaluation to discuss preventive and other strategies in today's challenging context

Economic evaluations of child and adolescent mental health interventions : a systematic review.

BACKGROUND : The need has grown over recent years for economic information on the impacts of child and adolescent mental helath problems and the cost-effectiveness of interventions. METHODS : A range of electronic databases were searched using a predefined search strategy. To identify economic studies which focused on services, pharmacological interventions and other treatments for children and adolescents with a diagnosed mental health problem or identified as at risk of mental illness. Published studies were included in the review if they assessed both costs and outcomes, with cost-effectiveness being the primary interest. Articles meeting the criteria for inclusion were assessed for quality. RESULTS : Behavioural disorders have been given relatively large attention in economic evaluations of child and adolescent mental health. These studies tentatively suggest child behavioural gains and parent satisfaction from parent and child training programmes, however the cost effectiveness of the location of delivery for behvaioural therapies is less clear. In general the quality of economic evaluations was limited by small sample sizes, a narrow conceptualisation of costs, narrow perspectives and limited statistical and econometric methods. CONCLUSIONS : Economic evaluations in the field of child and adolescent mental health services are few in number and generally poor in quality, although the number of studies being undertaken is now rising relatively quickly.

EQOLISE study finds Individual Placement and Support approach is effective in helping people with severe mental illness obtain competitive employment

People with severe mental illness face many challenges in securing paid work, and employment rates are low. For example, a five-country European study by Knapp et al (2002) found less than a quarter of people with schizophrenia were in paid employment, the proportion being as low as 5% in London. The economic and social impacts of employment difficulties are enormous. For individuals, it can mean long-term reliance on state welfare benefits, insecure low-paid work, and a disability trap that makes it hard to escape. For the broader society, the impacts are the risk of an almost permanently marginalized, socially excluded group of people, and high costs: productivity losses because of unemployment or absenteeism account for a large proportion of the overall cost of schizophrenia across many countries

Professor Martin Knapp: Autism Costs

Autism is often in the news. This past week the Center for Disease Control and Prevention (CDC) in the USA announced new estimates for prevalence: 1 child in every 88 has an autism spectrum disorder. This is a jump from their previous figures for the US, but actually almost identical to what Gillian Baird and colleagues found in South East England a few years ago in their 2006 Lancet article

The cost-effectiveness challenge: is it worth it?

Scarcity of resources means that difficult choices have to be made about to use them. Cost-effectiveness evidence provides a way to help decision-makers get ‘best value’ from their resources when choosing between two or more clinical or other interventions. Often it is found that one intervention has better outcomes than another, but also costs more. In these circumstances there is a need for the decision-maker to reach a view as to whether those better outcomes are ‘worth’ the higher costs, necessitating difficult trade-offs. Illustrations from the dementia field are given to illustrate how these trade-offs might be made. For strategic decisions it has often proved helpful to use a generic outcome measure such as the quality-adjusted life year (QALY). The fundamental aim of a healthcare system is not to save money, but to save and improve lives. Cost-effectiveness and similar analyses can help by showing how to get the most out of available resources

Savings on sanity

It is increasingly recognised across the world that intervening early in mental illness not only spares millions from untold misery but can save millions in finances. Martin Knapp provides an overview of a field of study that could transform this century and in which LSE leads the way