Cost effectiveness and medical cost-offset considerations in psychological service provision.

Abstract

Abstract Empirical evidence has demonstrated that psychological interventions can effectively treat a wide range of child and adult health problems. The focus of this review is on costing issues associated with psychological interventions, including cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to effective intervention). Recent evidence has demonstrated that psychological interventions can be more cost-effective than optimal drug treatment. For example, although having comparable effectiveness, cognitive-behavioural treatments for panic disorder and for depression have been estimated to cost approximately one-third less than pharmacological treatment. Furthermore, a recent meta-analysis of 91 research studies published between 1967 and 1997 found that average health care cost savings due to psychological intervention were in the range of 20-30% across studies, and 90% of the studies reported evidence of a medical cost offset. In conclusion, the evidence indicates that psychological treatments (i) can be cost-effective forms of treatment and (ii) have the potential to reduce health care costs, as successfully treated patients typically reduce their utilization of other health care services. Based on decades of research on the effects of psychological interventions, there is clear and compelling evidence that there are psychological interventions that are effective in treating a wide range of child and adult health problems, including depression, generalized anxiety disorder, panic disorder, post-traumatic stress disorder, eating disorders, substance abuse, and chronic pain (Chambless & Ollendick, 2001; Nathan & Gorman, 1998; Roth & Fonagy, 1996; U. K. Department of Health, 2001). As research continues to progress, there is mounting evidence that there are also effective psychological treatments for diseases and disorders that are routinely seen in primary care medical practices but that are typically difficult to medically manage, including Type I diabetes (Hampson et al., 2000), chronic tension-type headaches (Holroyd et al., 2001), rheumatoid arthritis (Sharpe et al., 2001), chronic low-back pain (van Tinder et al., 2000), chronic fatigue syndrome (Whiting et al., 2001), and a range of medically unexplained physical symptoms (Nezu, Nezu, & Lombardo, 2001). Evidence for the positive impact of psychological treatment is obviously important, but in the current context of accountability and cost containment, it is, on its own, insufficient (Mash & Hunsley, 1993). Psychologists involved in professional and public policy activities are well-aware of the critical need for data that address the costs associated with psychological services and the benefits - both in terms of health and economic factors - that are likely to result from these services (Dobson, 2002). Indeed, both national and provincial psychological associations have recently made submissions to government departments and commissions emphasizing the savings to the health care system that could result from greater accessibility to appropriate psychological services (e.g., Canadian Psychological Association, 2001; l'Ordre des Psychologues du Quebec, 2000; Manitoba Psychological Society, 2001; Saskatchewan Psychological Association, 2001). The primary goal of this article is to better acquaint psychologists with the costing concepts that can be, and have been, applied to the realm of psychological interventions and with the results of this line of research. I begin by reviewing the current fiscal situation in Canada as it relates to health care costs in general and psychological services more specifically. Next, an introduction to costing concepts is provided and analytic strategies for evaluating health care costs are presented. The next two sections deal specifically with evidence regarding cost savings that are likely to result from psychological treatment. Evidence for the costeffectiveness of psychological intervention versus pharmacologic intervention is presented for the treatment of two common psychological disorders: panic disorder and depression. …

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