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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 17, Issue 1, 2014. Pages: 3-8
Published Online: 1 March 2014

Copyright © 2014 ICMPE.


 

Cost Measurement of Mental Disorders in Germany

Helen Grupp,1 Hans-Helmut König,1 Alexander Konnopka1

1 Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

* Correspondence to: Helen Grupp, Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
Tel.: +49-040-7410 54202
Fax: +49-040-7410 54934
E-mail: h.grupp@uke.de

Source of Funding: This study was funded by the German Federal Ministry of Education and Research (grant number 01EH1101B).

Abstract

This systematic review analyses studies measuring costs of mental disorders in Germany regarding two  methodological aspects: Which cost categories are assessed? Is the used data source associated with specific study characteristics?A systematic literature search in PubMed was conducted and 31 cost-of-illness studies (COIs) and 17 cost-effectiveness analyses (CEAs) that measured patient-level data on direct costs of mental disorders in Germany were included. Most COIs and studies conducted from a societal perspective used patient-reported data which suited to assess cost categories comprehensively. Studies utilizing claims data or medical records tended to include fewer cost categories, but assessed costs over a longer period and were based on larger samples. Our review revealed the direct costs of mental disorders to be presumably underreported as relevant cost categories were often neglected. Furthermore, an improvement in the data collection with respect to methodological aspects is urgently required.

 

Background and Aims of the Study: Mental disorders are frequently investigated in economic evaluations. However, measuring direct costs of mental disorders is complex, in particular in Germany. We conducted a systematic review that investigated the following research questions: Which cost categories are assessed? Is the used data source (patient-reported data from interviews or questionnaires; claims data from health insurance; medical records from patient charts) associated with specific study characteristics?

Methods: We conducted a systematic literature search in PubMed. We included cost-of-illness studies (COIs) and cost-effectiveness analyses (CEAs) that measured patient level data on direct costs of mental disorders in Germany.

Results: We found 31 COIs and 17 CEAs. Cost items could be assigned to the cost categories outpatient medical, outpatient non-medical, sheltered living, hospital, rehabilitation, nursing care, outpatient goods (medication and medical goods), other direct costs, and indirect costs. Most studies, in particular COIs and studies conducted from a societal perspective, used patient-reported data which suited to assess cost categories comprehensively. Studies based on claims data or medical records tended to include fewer cost categories.

Discussion: The sample size of 48 analyzed studies was rather small. However, our study investigated three methods to assess health care utilization -- using patient-reported data, claims data, or medical records -- and identified their respective strengths and weaknesses in the context of covered cost categories and further attributes.

Conclusion: Studies measuring the direct costs of mental disorders in Germany mostly relied on patient-reported data to assess resource consumption. Although more objective, claims data were used less frequently and covered less cost categories.

Implications for Health Policies: The direct costs of mental disorders are likely to be underreported as relevant cost factors such as non-medical services or sheltered living were often neglected in the studies. Policy makers should consider this when deciding on measures that aim at reducing the costs of care.

Implications for Further Research: Eliciting data from patients seems to constitute an adequate instrument to assess a broad range of cost categories, even though this bears various methodological challenges. Further research should (i) ameliorate the methods of collecting data from patients in ensuring that all relevant costs are covered and that methodological flaws are minimised (ii) develop or improve methods for the combination of claims data from different data holders.

Received 2 May 2013; accepted 23 December 2013

Copyright 2014 ICMPE