Measuring resource use in economic evaluations: Determining the social costs of mental illness

Abstract

Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement.

Legal System Involvement and Costs for Persons in Treatment for Severe Mental Illness and Substance Use Disorders

“…Sullivan and Spritzer (13) documented systematic use of jails as temporary holding facilities for persons with serious mental illness in rural areas. Legal processes associated with involuntary commitment and guardianship, police assistance in psychiatric emergencies, and the role of law enforcement officials in transporting persons with serious mental illness to treatment facilities may also contribute to costs incurred by the legal system (14).…”

A Randomized Trial of Clozapine Versus Other Antipsychotics for Cannabis Use Disorder in Patients With Schizophrenia

“…The SANS was used to assess five negative symptom components on a scale of 0 = ‘not at all’ to 5 = ‘severe.’ Unblinded clinicians measured neurologic side effects weekly with the Simpson Angus (Simpson & Angus, 1970), the Abnormal Involuntary Movement Scale (Lane, Glazer, Hansen, Berman, & Kramer, 1985), and the Barnes Akathisia Rating Scales (Barnes, 1989). At baseline and monthly thereafter, blinded raters assessed the amount of services patients received to address their alcohol use disorder with a substance use treatment services questionnaire (Clark et al, 1994). Study physicians recorded medication dose at each visit.…”

The role of public and private transfers in the cost‐benefit analysis of mental health programs

“…As Hu and Jerrell -hereafter H&J -point out, the literature includes cases where all maintenance costs are considered treatment costs, as in Rice [2], and others where these costs have been only partially included, see McGuire et al [3]. At the other extreme, we have Clark et al [4] who argue that none of these costs are resource costs.…”

“…Then we use this equation to show that earlier results can be obtained as special cases. Start with the simple efficiency cost-benefit criterion, given earlier as Equation (4), that has benefits and costs inclusive of the production function effect of transfers:…”