Session 5 Economic evaluation

1. Session 5Economic evaluation

2. Session 5 structure • Economic evaluation • Evidence for cost effectiveness DataPrev Training Module - Session 5 - Economic evaluation

3. The importance of economic evaluation • Understandresourcesrequired • Understandeconomicimpact • Aid decisionmaking in situations of: • Limitedbudgets • Limitedhumanresources DataPrev Training Module - Session 5 - Economic evaluation

4. Assessing the cost effectiveness of a school-based intervention: DataPrev Training Module - Session 5 - Economic evaluation

5. economic evaluation Measuring costs • Monetary costs of a programme (e.g., professional training, staff time, use of buildings and equipment) • Non-monetary inputs (e.g., contribution of unpaid volunteers • Immediate costs of delivery and impact on future costs. • Impact on costs in other settings and sectors DataPrev Training Module - Session 5 - Economic evaluation

6. economic evaluation Types of economicevaluation • Cost effectiveness analysis (CEA), compares costs with a single outcome dimension, e.g., level of educational achievement, rate of return to employment or a symptom-specific measure. • Cost consequence analysis (CCA) compares costs with a range of outcomes for interventions, without making any judgement as to which outcome is of more importance. This judgement is left to decision-makers. DataPrev Training Module - Session 5 - Economic evaluation

7. economic evaluation Types of economicevaluationcont. • Cost utility analysis - common measure of outcomes (‘utilities’, e.g., QALY and DALY), allowing decision-makers to compare investing in mental health promotion vs. other public health interventions or health care treatments. • Cost benefit analysis (CBA) - all costs and outcomes are valued in monetary terms (Challenges in obtaining meaningful values from cost–benefit analysis). CBA widely used in different sectors enables the decision-maker to compare investing in MHP/MDPvs.investingin any area of the economy. DataPrev Training Module - Session 5 - Economic evaluation

8. Evidence for cost effectiveness The DataPrev review of economic evidence • Economic evaluations (comparing effectivenes and costs prospectively or retrospectively) • Promotion and primary prevention (except parents with MH problems – 1º prevention for children) • In the 4 DataPrev areas : Parents, schools, workplace and older people DataPrev Training Module - Session 5 - Economic evaluation

9. Evidence for cost effectiveness Parenting and early years • Home visiting (by nurses or health visitors) • Nurse Family Partnership - Benefits outweighed costs by a factor of 5.7 to 1 for high risk women and 1.26 to 1 for low risk women • Health visits for high risk of post-natal depression - 90% chance that the cost per QALY gained would be less than £30,000 (cost effective) DataPrev Training Module - Session 5 - Economic evaluation

10. Evidence for cost effectiveness Parenting and early years cont. • Parenting programmes • IncredibleYears Programme– most cost effective: • for children with highest risk of developing conduct disorder • combined with child-based training and teacher training • where uptake and engagement rates improved • multi-component, manualised multi-level Triple P-Positive Parenting Programme- an economic model predicted that the costs could be recovered in one year through a modest 10% reduction in the rate of child abuse and neglect DataPrev Training Module - Session 5 - Economic evaluation

11. Evidence for cost effectiveness School based interventions • Embedded in thecommunity (sometimescombinedwithparentinginterventions) • Caring School Community– can potentially generate a return on investment of 28:1 (through reduced drug and alcohol problems alone) • Good Behaviour Game (GBG)- return on investment of 25:1 (reduction in tobacco use alone) • PATHS (Promoting Alternative Thinking Strategies) - 66% chance of having a cost per QALY gained of less than £30,000 DataPrev Training Module - Session 5 - Economic evaluation

12. Evidence for cost effectiveness Promoting mental health at the workplace • Organisational level interventions with economic benefits: • stress and well-being audits, • better integration of occupational and primary health care systems • extension in flexible working hours arrangements (Foresight Mental Capital and Wellbeing Project 2008). DataPrev Training Module - Session 5 - Economic evaluation

13. Evidence for cost effectiveness • Programmes to increase individual resilience in the workplace: • Johnson and Johnson wellness programme (incl stress management) - $225 reduction in health care costs per employee per annum • Highmark company wellness programme (incl stress management classes and on-line advice) - return of $1.65 on every $1 invested (health care costs) • multi-component workplace based health promotion programme (personalised health and WB information and advice; health risk appraisal, web portal, wellness literature, and seminars and workshops on wellness issues) – 6x ROI (at £70 per employee) due to reduced absenteeism and improvements in workplace productivity DataPrev Training Module - Session 5 - Economic evaluation

14. Benefits associated with UK wellness programmes (PricewaterhouseCoopers LLP, 2008) DataPrev Training Module - Session 5 - Economic evaluation

15. Evidence for cost effectiveness Investing in the mental health and wellbeing of older people • home visiting interventions (mixed evidence) • trained volunteers + brochure on depression - 70% chance of being cost effective, with a baseline cost per QALY gained of €6,827 (health service costs avoided) DataPrev Training Module - Session 5 - Economic evaluation

16. Evidence for cost effectiveness Investing in the mental health and wellbeing of older people • Group activities can be cost effective: • Exercise classes - cost per QALY gained of €17,172 • Group activity sessions led by occupational therapists - incremental cost per QALYgained (cost effective for health and social care) • Psychosocial group therapy - €943 reduction in health care costs per participant DataPrev Training Module - Session 5 - Economic evaluation

17. Evidence for cost effectiveness Investing in the mental health and wellbeing of older people A cost-effective approach can be achieved by: • identifying the risk factors(e.g. widowhood, loneliness) • screening the elderly population for risk factors (e.g. in health services) • targeting effective preventive interventions towards the indicated high-risk groups. DataPrev Training Module - Session 5 - Economic evaluation