Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders

Abstract

BackgroundResources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses.Scope and methodsThe aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012.FindingsSixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8).ConclusionOnly 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders.

Adolescent mental health—Opportunity and obligation

“…Yet, studies of interventions’ economic effect have not demonstrated consistent benefits, which may be due, in part, to assessment of treatments that are not biologically based and/or do not consider how neurodevelopmental changes affect long-term effectiveness (5). …”

Impact of Attention-Deficit Hyperactivity Disorder on School Performance: What are the Effects of Medication?

“…Not surprisingly, ADHD contributes to increased risk for problems in education, thus conferring a substantial burden on healthcare and educational systems worldwide [7][8][9][10]. School functioning and academic achievement are frequently and in many cases profoundly impaired by ADHD.…”

Low-intensity interventions for anxiety disorders

“…7 In view of the current climate of financial austerity, Creswell and colleagues' findings are important and highlight how interventions of similar length delivered in different ways need to be compared not just for their clinical differences, but also for their cost differences. In this instance, use of brief telephone contacts reduced the need for face-to-face consultations and associated travel costs and time off work or school to attend clinic appointments.…”