Dynamic cost benefit analysis for mental health reform

Abstract

PurposeThis paper aims to describe the application of system dynamics to enhance traditional cost benefit analysis (CBA) in planning a significant expansion of therapy capacity for mental health treatment in the UK. The aim of the initiative is to benefit the health of individuals, reduce costs to society and the exchequer and increase employment.Design/methodology/approachThe paper describes a conventional CBA and comments on its merits and limitations. The development and use of a system dynamics model of the situation is then described, together with how this complements and supports the conventional analysis and its outcome.FindingsBy focussing analysis on the dynamics of people flows over time, simulation is shown to assist understanding of the issue and its potential benefits. The numbers of patients expected to benefit is shown to depend on the treatment capacity, on the sources of people presenting, the number and type of treatment channels and their parameters, the success of treatment, the provision for patients moving between treatment channels, the dynamics of the labour market and employment opportunities.Originality/valueThe paper is totally original and has provided decision support to a large investment on which implementation has begun. The overall methodological conclusion is that dynamic factors are often left out of CBA because they cause too much complexity for decision makers, whereas system dynamics allows these factors to be included without masking the clarity of the case. The paper suggests that CBA and system dynamics are very complementary.

System Dynamics Approaches and Collective Action for Community Health: An Integrative Review

“…Wolstenholme, Monk, and Todd () described how they applied system dynamics modeling to support policymakers in deciding on investments for mental health treatment therapies. A group of national experts and stakeholders were brought together to define an alternative service configuration.…”

“…Action documented (with or without learning or decision-making/recommendations) (n = 7) Homer et al (2004). X X X X X Wolstenholme et al (2010). X X X X X Loyo et al (2013).…”

Modeling disease progression and treatment pathways for depression jointly using agent based modeling and system dynamics

“…In mental healthcare, studies have addressed problems such as implementation of a treatment strategy in a mental health facility ( 48 , 49 ); cost-benefit analysis at the same time capturing different sectors (treatment and recovery, therapist, and labor market) ( 50 ); patient flow from GP to hospital ( 46 ); mental health in prison and forensic sectors ( 51 ), in military system ( 52 ), or community center ( 53 ); disease progression by incorporating factors associated to depression ( 54 ) or by describing different parts of brain in schizophrenia ( 55 ).…”

A study of home telehealth diffusion among US home healthcare agencies using system dynamics

“…SD methodology has been applied to examine policy interventions and study innovation diffusion in different systems including healthcare. Many researchers utilized SD for policy analysis in various healthcare settings such as chronic care management (Homer et al, 2004), mental health treatment (Schwaninger et al, 2010), cardiac catheterization services (Taylor and Dangerfield, 2004), ambulatory healthcare services (Diaz et al, 2012), long-term care services (Ansah et al, 2014), primary and acute care services (Lane and Husemann, 2008;Lyons and Duggan, 2014), and the entire national healthcare system (Wolstenholme, 1999). Others performed simulation analysis on patient flow to examine the impacts of Information Technology (IT) diffusion in healthcare (Bayer et al, 2007;Osipenko, 2005).…”