Health economics and cost implications of anxiety and other mental disorders in the United States

Abstract

Background Mental disorders impose a multi-billion dollar burden on the economy each year; translating the burden into economic terms is important to facilitate formulating policies about the use of resources.Method For direct costs, data were obtained from national household interview and provider surveys; for morbidity costs, a timing model was used that measures the lifetime effect on current income of individuals with mental disorders, taking into account the timing of onset and the duration of these disorders, based on regression analysis of Epidemiologic Catchment Area study data.Results The total economic costs of mental disorders amounted to US$ 147.8 billion in 1990. Anxiety disorders are the most costly, amounting to $46.6 billion, or 31.5% of the total; schizophrenic disorders accounted for $32.5 billion, affective disorders for $30.4 billion, and other mental disorders for $38.4 billion.Conclusions Mental illnesses, especially anxiety disorders, are costly to society. Although anxiety disorders have a higher prevalence than affective disorders and schizophrenia, use of medical care services is lowest for anxiety disorders. Anxiety disorders appear to be under-recognised and untreated even though treatment interventions have been shown to be effective and can be delivered in a cost-efficient manner.

Routine outcome monitoring in clinical practice: service and non-service costs of psychiatric patients attending a Community Mental Health Centre in Italy

“…Our estimate of non-service costs in patients suffering from schizophrenia and related disorders supports this viewpoint -48% of total costs was in fact attributed to non-service costs, mainly patients' lack of job opportunities -is in line with some other studies of the costs of schizophrenia (Knapp 1997;Rice and Miller, 1998) although different definitions of non-service costs and different ways of valuing them led to different patterns (Knapp et al, 2002). For patients who are not schizophrenic, moreover, only 36% of total costs was attributed to non-service costs, which is substantially lower than some previous findings.…”

“…Although most completed cost-of-illness studies have employed the human capital approach to measure non-service costs, other methods have been suggested including the "friction costs" and "willingness-to-pay" approaches (Rice and Miller, 1998). In this study the human capital approach was used to estimate non-service costs due to illness.…”

“…For patients who are not schizophrenic, moreover, only 36% of total costs was attributed to non-service costs, which is substantially lower than some previous findings. Rice and Miller (1998) showed that, for patients suffering from anxiety disorder, non-service costs were more than three times than direct costs, and for patients with depression indirect costs have been estimated to account for the majority of overall costs (Stoudemire et al, 1986;Kind and Sorenson, 1993;Greenberg et al, 1993). One possible explanation for the lower rates of non-service costs in the present study could be because the naturalistic approach adopted determined the inclusion of patients who had been in contact with the service for many years, were clinically stable and who required long-term support to live in the community.…”

“…Amaddeo et al, 1997; Rice and Miller, 1998; McCrone et al, 1998; Knapp et al, 2002). This paucity of evidence can in part be explained by the methodological difficulties of collecting cost-related information in the routine work of a community psychiatric service and in estimating non-service costs in monetary terms.…”

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…); method of management of drop-outs described (e.g., last observation carried forward/LOCF, mixed model repeated measures analysis/MMRM) Á Fulfillment of good clinical practice (GCP) criteria Á Approval by properly-constituted ethics committee *These points are part of the Jadad Score Jadad et al 1996 approximately one-third of the total expenditures for mental illness (DuPont et al 1996;Rice and Miller 1998;Wittchen 2002). In primary care, anxiety disorders are often underdiagnosed (Sartorius et al 1996) or recognized only years after onset.…”