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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 16, Issue 4, 2013. Pages: 161-177
Published Online: 1 December 2013

Copyright © 2013 ICMPE.


Costs and Benefits of Improving Access to Psychotherapies for Common Mental Disorders

Anne Dezetter,1 Xavier Briffault,2 Christian Ben Lakhdar,3 Viviane Kovess-Masfety4

1Ph.D, EA4069, Ecole des Hautes Etudes en Santé Publique (EHESP) -- Paris Descartes University, Sorbonne Paris Cité, Paris, France; CERMES3 - CESAMES, Paris Descartes University, Sorbonne Paris Cité, Paris, France
2Ph.D, CERMES3 - CESAMES, Paris Descartes University, Sorbonne Paris Cité, Paris, France
3Ph.D, Université Catholique de Lille (FLEG), LEM UMR 8179 CNRS, ISTC Strategies & Communication, Lille, France
4M.D, Ph.D, EA4069, Ecole des Hautes Etudes en Santé Publique (EHESP) -- Paris Descartes University, Sorbonne Paris Cité, Paris, France

* Correspondence to: Dr. Anne Dezetter, CERMES3-CESAMES, Via Anne Toppani 45 rue des Saints-Pères 75270 Paris Cedex 06, France.
Tel.: +33-14-286 4004
Fax: +33-14-286 3876
E-mail: anne.dezetter@gmail.com

Source of Funding: Partially supported by CNAM-TS (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés [French National Public Health Insurance for Employees]).


Structured psychotherapies are effective and recommended treatments for mental disorders. Nevertheless, in France, psychotherapies are not reimbursed by health cover systems. A financial evaluation of covering the cost of psychotherapies was performed using the methodology of the British programme Improving Access for Psychological Therapies. The cost of a session was estimated at 41€, the reimbursement rate by the compulsory health insurance system at 60% for the care of individuals aged 18 to 75 presenting common, chronic and/or severe mental disorders. The annual costs of disorders were estimated to be between 4,702€ and 1,500€. The remission rate attributable to psychotherapies was estimated to be 30% ±10%. Funding psychotherapies proves to be a cost-efficient investment. The yearly cost of psychotherapies for the compulsory cover system would be 308 million Euros, to treat 1.033 million patients. 1€ spent for the psychotherapy would enable the community savings between 1.14€ and 1.95€.

Background: Structured psychotherapies are treatments used in common mental health disorders (CMHDs) that are recommended by international good practice guidelines. Their efficacy and positive impact on health -- and thereby on the reduction of related costs for health insurance schemes and society -- have been widely demonstrated. However in France, despite the considerable financial burden of CMHDs, psychotherapies with a non-medical psychotherapist are not reimbursed by the health insurance schemes.

Aims of the Study: To assess the cost of coverage for psychotherapies by the health insurance bodies for adults aged 18 to 75 with CMHDs -depressive or anxious disorders, severe or recurrent- and to estimate the cost-benefit ratio for these psychotherapies for the community.

Methods: The data was derived from l'Enquête Indicateurs de santé mentale dans quatre régions françaises 2005, which is a cross-sectional study on 20,777 adults in the general population. Telephone interviews were backed up by the CIDI-SF. The Sheehan Disability Scale was used to assess the severity of the disorders. The proportion of patients who would agree to and then attend psychotherapies was estimated using the methodology developed in the UK in the Improving Access to Psychological Therapies programme, adapted to the French setting. The number of sessions to be covered was defined according to recommendations by the National Institute for Health and Clinical Excellence. The cost was estimated to be 41 per session, the reimbursement rate was set at 60% for the compulsory health coverage system. The annual costs engendered by CMHDs were estimated to be 4,702 for depressive disorders and 1,500 for anxiety disorders. The remission rate attributable to psychotherapies was estimated to be 30% \pm10%.

Results: For average series of 10 sessions (anxiety disorders) to 18 sessions (depressive disorders) the yearly cost of psychotherapies would be 514 million Euros, of which 308 million would be covered by the compulsory coverage system, to treat 1.033 million patients, or 2.3% of the population. For patients with depressive disorders, 1 spent by the community for the psychotherapy would enable the community a saving of 1.95 (1.30-2.60), and for anxiety disorders a saving of 1.14 (0.76-1.52).

Discussion: This programme for provision of coverage for psychotherapies would have a positive impact for the community as a whole, in terms of quality-of-life, health and absenteeism. Funding psychotherapies proves to be a cost-efficient investment in the short and the long term, and this is backed up further by the fact that the impact of psychotherapies on somatic disorders interacting with CMHDs was not taken into account here.

Implications for Health Policies, Health Care Provision and Use: Decision-makers in the health insurance schemes will thus have reliable medico-economic data available to assist in decisions for a possible policy for reimbursement of psychotherapies. Financial coverage of psychotherapies would in particular enable access to treatment by people for whom the financial barrier would have prevented access to this treatment. Furthermore, reimbursing sessions with non-medical psychotherapists could also improve conditions of care-provision by mental health professionals. Finally, this model could be replicated in other countries where the health system is sufficiently comparable to that prevailing in France.

Implications for Future Research: An in-depth study is required to detail cost and benefit of providing insurance coverage for psychotherapies for the different protagonists involved in this funding, and its effects.

Received 20 September 2012; accepted 17 October 2013

Copyright 2013 ICMPE