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The British Journal of Psychiatry (2004) 184: 526-533
© 2004 The Royal College of Psychiatrists

Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders

Gavin Andrews, FRCPsych and Cathy Issakidis, PhD

World Health Organization Collaborating Centre for Mental Health Policy, and Policy and Epidemiology Group, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Sydney

Kristy Sanderson, PhD

World Health Organization Collaborating Centre for Mental Health Policy, and Policy Epidemiology Group, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Sydney and Centre for Health Research, School of Public Health, Queensland University of Technology, Brisbane

Justine Corry, M Clin Psychol

World Health Organization Collaborating Centre for Mental Health Policy, and Policy and Epidemiology Group, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Sydney

Helen Lapsley, MEc

World Health Organization Collaborating Centre for Mental Health Policy, and Policy and Epidemiology Group, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Sydney and Faculty of Health Sciences, University of Queensland, Brisbane, Australia

Correspondence: Professor Gavin Andrews, 299 Forbes Street, Darlinghurst, NSW 2010, Australia. Fax: +612 9332 4316; e-mail: gavina{at}unsw.edu.au

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Mental health survey data are now being used proactively to decide how the burden of disease might best be reduced.

Aims To study the cost-effectiveness of current and optimal treatments for mental disorders and the proportion of burden avertable by each.

Method Data for three affective, four anxiety and two alcohol use disorders and for schizophrenia were compared interms of cost, burden averted and efficiency of current and optimal treatment. We then calculated the burden unavertable given current knowledge. The unit of health gain was a reduction in the years lived with disability (YLDs).

Results Summing across all disorders, current treatment averted 13% of the burden, at an average cost of AUS$30 000 per YLD gained. Optimal treatment at current coverage could avert 20% of the burden, at an average cost of AUS$18 000 per YLD gained. Optimal treatment at optimal coverage could avert 28% of the burden, at AUS$16 000 per YLD gained. Sixty per cent of the burden of mental disorders was deemed to be unavertable.

Conclusions The efficiency of treatment varied more than tenfold across disorders. Although coverage of some of the more efficient treatments should be extended, other factors justify continued use of less-efficient treatments for some disorders.

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