Equity, Efficiency and Research Synthesis

McDaid, David; Sassi, Franco

doi:10.1002/9781444320398.ch6

Cited by 8 publications

(5 citation statements)

References 46 publications

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“…Few studies undertook more than a very cursory sensitivity analysis to account for uncertainty around estimates of effect and cost. There was little discussion of the distributional impacts of interventions, an issue that is of particular relevance in the context of public health and health promotion interventions, where engagement and uptake can be critical to effectiveness ( McDaid and Sassi, 2010 ).…”

Section: Discussionmentioning

confidence: 99%

Investing in mental health and well-being: findings from the DataPrev project

McDaid

Park

2011

Health Promotion International

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A systematic review was conducted to determine the extent to which an economic case has been made in high-income countries for investment in interventions to promote mental health and well-being. We focused on areas of interest to the DataPrev project: early years and parenting interventions, actions set in schools and workplaces and measures targeted at older people. Economic evaluations had to have some focus on promotion of mental health and well-being and/or primary prevention of poor mental health through health-related means. Studies preventing exacerbations in existing mental health problems were excluded, with the exception of support for parents with mental health problems, which might indirectly affect the mental health of their children. Overall 47 studies were identified. There was considerable variability in their quality, with a variety of outcome measures and different perspectives: societal, public purse, employer or health system used, making policy comparisons difficult. Caution must therefore be exercised in interpreting results, but the case for investment in parenting and health visitor-related programmes appears most strong, especially when impacts beyond the health sector are taken into account. In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects (largely in the USA) was reported, while group-based exercise and psychosocial interventions are of potential benefit to older people. Many gaps remain; a key first step would be to make more use of the existence evidence base on effectiveness and model mid- to long-term costs and benefits of action in different contexts and settings.

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Section: Discussionmentioning

confidence: 99%

Investing in mental health and well-being: findings from the DataPrev project

McDaid

Park

2011

Health Promotion International

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“…It is also important to consider cost effectiveness for population sub-groups as cost effectiveness ratios for the population as a whole may not reflect the cost effectiveness of the intervention for specific population groups, for instance related to age, gender, diagnosis or living conditions [74]. Few of the studies undertaken to date have looked at sub-groups, although there can be very different conclusions drawn on what is cost effective, as in the case of the evaluation of HIV risk reduction programmes for men or women [48].…”

Section: Discussionmentioning

confidence: 99%

Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review

et al. 2013

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BackgroundRecently attention has begun to focus not only on assessing the effectiveness of interventions to tackle mental health problems, but also on measures to prevent physical co-morbidity. Individuals with mental health problems are at significantly increased risk of chronic physical health problems, such as cardiovascular disease or diabetes, as well as reduced life expectancy. The excess costs of co-morbid physical and mental health problems are substantial. Potentially, measures to reduce the risk of co-morbid physical health problems may represent excellent value for money.MethodsTo conduct a systematic review to determine what is known about economic evaluations of actions to promote better physical health in individuals identified as having a clinically diagnosed mental disorder, but no physical co-morbidity. Systematic searches of databases were supplemented by hand searches of relevant journals and websites.ResultsOf 1970 studies originally assessed, 11 met our inclusion criteria. In addition, five protocols for other studies were also identified. Studies looked at exercise programmes, nutritional advice, smoking, alcohol and drug cessation, and reducing the risk of blood borne infectious diseases such as HIV/AIDS and hepatitis. All of the lifestyle and smoking cessation studies focused on people with depression and anxiety disorders. Substance abuse and infectious disease prevention studies focused on people with psychoses and bipolar disorder.ConclusionsThere is a very small, albeit growing, literature on the cost effectiveness of interventions to promote the physical health of people with mental health problems. Most studies suggest that value for money actions in specific contexts and settings are available. Given that the success or failure of health promoting interventions can be very context specific, more studies are needed in more settings, focused on different population groups with different mental health problems and reporting intermediate and long term outcomes. There is a need to better distinguish between resource use and costs in a transparent manner, including impacts outside of the health care system. Issues such as programme fidelity, uptake and adherence should also be accounted for in economic analysis. The role of behavioural psychological techniques to influence health behaviours might also be considered.

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“…A second way is by prompting consideration of how costs and cost-effectiveness might vary between different population sub-groups. Consideration of how effectiveness might vary between sub-groups is commonly addressed in Cochrane intervention reviews, but the addition of an economic lens might help focus on 'economic’ reasons why behaviour differs between sub-groups in addition to biological or clinical reasons [ 18 ]. An example, of this might be to consider how the uptake and efficiency of public health interventions varies between socioeconomic groups according to the type and magnitude of financial incentives provided.…”

Section: Methodsmentioning

confidence: 99%

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

et al. 2013

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BackgroundMethods for systematic reviews of the effects of health interventions have focused mainly on addressing the question of 'What works?’ or 'Is this intervention effective in achieving one or more specific outcomes?’ Addressing the question 'Is it worth it given the resources available?’ has received less attention. This latter question can be addressed by applying an economic lens to the systematic review process.This paper reflects on the value and desire for the consideration by end users for coverage of an economic perspective in a Cochrane review and outlines two potential approaches and future directions.MethodsTwo frameworks to guide review authors who are seeking to include an economic perspective are outlined. The first involves conducting a full systematic review of economic evaluations that is integrated into a review of intervention effects. The second involves developing a brief economic commentary. The two approaches share a set of common stages but allow the tailoring of the economic component of the Cochrane review to the skills and resources available to the review team.ResultsThe number of studies using the methods outlined in the paper is limited, and further examples are needed both to explore the value of these approaches and to further develop them. The rate of progress will hinge on the organisational leadership, capacity and resources available to the CCEMG, author teams and other Cochrane entities. Particular methodological challenges to overcome relate to understanding the key economic trade-offs and casual relationships for a given decision problem and informing the development of evaluations designed to support local decision-makers.ConclusionsMethods for incorporating economic perspectives and evidence into Cochrane intervention reviews are established. Their role is not to provide a precise estimate of 'cost-effectiveness’ but rather to help end-users of Cochrane reviews to determine the implications of the economic components of reviews for their own specific decisions.

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Equity, Efficiency and Research Synthesis

Cited by 8 publications

References 46 publications

Investing in mental health and well-being: findings from the DataPrev project

Investing in mental health and well-being: findings from the DataPrev project

Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

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